Provider Demographics
NPI:1134172208
Name:MARCUM, PATTI JO
Entity type:Individual
Prefix:DR
First Name:PATTI
Middle Name:JO
Last Name:MARCUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1448 10TH AVENUE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-3579
Mailing Address - Country:US
Mailing Address - Phone:304-691-6381
Mailing Address - Fax:304-691-8591
Practice Address - Street 1:7718 COUNTY ROAD 107
Practice Address - Street 2:
Practice Address - City:PROCTORVILLE
Practice Address - State:OH
Practice Address - Zip Code:45669-7928
Practice Address - Country:US
Practice Address - Phone:740-886-1150
Practice Address - Fax:408-861-1777
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV21026207Q00000X
OH35.133829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0010721914OtherMOUNTAIN STATE BC/BS
KY64089758Medicaid
WV3004276000Medicaid
WVH92072Medicare UPIN
WV7380721Medicare PIN