Provider Demographics
NPI:1871511139
Name:GOLLOBER, MARCIA J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:J
Last Name:GOLLOBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:ATTN: CREDENTIALING/PAYER ENROLLMENT
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2081 BRONZE STAR DR
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95776-5423
Practice Address - Country:US
Practice Address - Phone:530-668-2600
Practice Address - Fax:530-661-1081
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2017-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG64012207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G640122Medicare PIN
00G640122Medicare PIN
CA00G640120OtherBLUE SHIELD