Provider Demographics
NPI:1881690915
Name:GRASSI, MARCELLE (MD)
Entity Type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:GRASSI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 WALDEN AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-4757
Mailing Address - Country:US
Mailing Address - Phone:716-651-0726
Mailing Address - Fax:716-651-0729
Practice Address - Street 1:2560 WALDEN AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4757
Practice Address - Country:US
Practice Address - Phone:716-651-0726
Practice Address - Fax:716-651-0729
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183972207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA1046Medicare UPIN