Provider Demographics
NPI:1023354586
Name:MARCELO, PETRONILO JR
Entity type:Individual
Prefix:
First Name:PETRONILO
Middle Name:
Last Name:MARCELO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 WOODRUFF CT
Mailing Address - Street 2:
Mailing Address - City:HUBERT
Mailing Address - State:NC
Mailing Address - Zip Code:28539
Mailing Address - Country:US
Mailing Address - Phone:619-341-1076
Mailing Address - Fax:
Practice Address - Street 1:2ND MEDICAL BATTALION PSC BOX 20129
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28454-0129
Practice Address - Country:US
Practice Address - Phone:910-451-6943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-02
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman