Provider Demographics
NPI:1902858483
Name:JAEGER, MARCELLA M (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLA
Middle Name:M
Last Name:JAEGER
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 1:203 BAURER CIR
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-6775
Mailing Address - Country:US
Mailing Address - Phone:916-743-0968
Mailing Address - Fax:
Practice Address - Street 1:4062 FLYING C RD
Practice Address - Street 2:
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-9664
Practice Address - Country:US
Practice Address - Phone:530-676-8230
Practice Address - Fax:530-676-0819
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG87379207Q00000X
MO2000148102207Q00000X
IL036-101304207Q00000X
AL18516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G87379Medicaid
AL18516OtherSTATE LICENSE
MO2000148102OtherSTATE LICENSE
IL036-101304OtherSTATE LICENSE
CAG87379OtherSTATE LICENSE
CAG87379OtherSTATE LICENSE
CAG87379OtherSTATE LICENSE
CAH04104Medicare UPIN