Provider Demographics
NPI:1851320725
Name:MARQUES, MARISA
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:MARQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 19TH ST S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:619 19TH ST S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1900
Practice Address - Country:US
Practice Address - Phone:205-934-4011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL19961207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000008067Medicaid
AL051534335OtherBLUE CROSS
ALG88128OtherVIVA
AL000008067OtherBLUE CROSS
AL009937198Medicaid
AL220026044OtherRAILROAD MEDICARE
MS00124484OtherMISSISSIPPI MEDICAID
AL010033CG88128OtherSECTION 1011
LA1594814OtherEMERGENCY LA MEDICAID
AL009937198Medicaid