Provider Demographics
NPI:1972594414
Name:PORCELLI, MARCUS PETER (MD)
Entity Type:Individual
Prefix:
First Name:MARCUS
Middle Name:PETER
Last Name:PORCELLI
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 1:629 CRANBURY RD FL 2
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-4096
Mailing Address - Country:US
Mailing Address - Phone:732-390-7750
Mailing Address - Fax:732-390-7725
Practice Address - Street 1:75 VERONICA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-246-4882
Practice Address - Fax:732-249-5633
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04695200207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1801850243OtherRCCA GROUP NPI#
NJ295909OtherGROUP MEDICARE #
NJ1265623169OtherGROUP NPI
NJ1972594414OtherINDIVIDUAL NPI
NJ648329OtherMEDICARE GROUP PROVIDER
NJ1790396281OtherTITAN HEALTH GROUP NPI#
NJ4589301Medicaid
NJ648329Medicare ID - Type Unspecified
E84481Medicare UPIN