Provider Demographics
NPI:1861470767
Name:MARCOTTE, GREGORY V (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:V
Last Name:MARCOTTE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 PRIDES XING STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-6109
Mailing Address - Country:US
Mailing Address - Phone:302-998-0300
Mailing Address - Fax:302-999-7943
Practice Address - Street 1:1401 FOULK RD STE 205
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-2764
Practice Address - Country:US
Practice Address - Phone:302-998-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004987207KA0200X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
030003889OtherRAILROAD MEDICARE
DE0001007701Medicaid
000463A48Medicare PIN
F96218Medicare UPIN
DE0001007701Medicaid