Provider Demographics
NPI:1255445854
Name:MARCISZ, THOMAS JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:MARCISZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28683 MOUNTAIN LILAC RD
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-6203
Mailing Address - Country:US
Mailing Address - Phone:760-739-8314
Mailing Address - Fax:760-739-8841
Practice Address - Street 1:624 EAST GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-739-8314
Practice Address - Fax:760-739-8841
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60509207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G605090Medicaid
C36164Medicare UPIN
CAG60509Medicare ID - Type Unspecified