Provider Demographics
NPI:1457379554
Name:PAVESI, MARCO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:
Last Name:PAVESI
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 1:2557 MOWRY AVE
Mailing Address - Street 2:SUITE 12
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1603
Mailing Address - Country:US
Mailing Address - Phone:510-793-3722
Mailing Address - Fax:510-793-8783
Practice Address - Street 1:2557 MOWRY AVE
Practice Address - Street 2:SUITE 12
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1603
Practice Address - Country:US
Practice Address - Phone:510-793-3722
Practice Address - Fax:510-793-8783
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42767207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB85982Medicare UPIN