Provider Demographics
NPI:1942303128
Name:MARROCCO PLASTIC SURGERY, PC
Entity Type:Organization
Organization Name:MARROCCO PLASTIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARROCCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-815-8985
Mailing Address - Street 1:PO BOX 68952
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-0952
Mailing Address - Country:US
Mailing Address - Phone:317-870-6745
Mailing Address - Fax:317-870-0499
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:SUITE #202
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-815-8985
Practice Address - Fax:317-815-8982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200329230AMedicaid
IN200329230AMedicaid