Provider Demographics
NPI:1649294935
Name:MARASCALCO, DON E (MD)
Entity type:Individual
Prefix:DR
First Name:DON
Middle Name:E
Last Name:MARASCALCO
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:PO BOX 1551
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-1551
Mailing Address - Country:US
Mailing Address - Phone:601-485-2368
Mailing Address - Fax:601-693-2174
Practice Address - Street 1:1301 20TH AVE
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301-4121
Practice Address - Country:US
Practice Address - Phone:601-485-2368
Practice Address - Fax:601-693-2174
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS009634207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL180041976OtherRAILROAD MEDICARE
MSCH5554OtherRAILROAD MEDICARE GROUP
MS180041626OtherRAILROAD MEDICARE
AL051550436Medicaid
ALCH6608OtherRAILROAD GROUP ID
MS00116642Medicaid
ALI424Medicare ID - Type UnspecifiedGROUP PROVIDER ID
AL180041976OtherRAILROAD MEDICARE
MSB65730Medicare UPIN
ALB65730Medicare UPIN
MSC02590Medicare PIN
MSC02590Medicare ID - Type UnspecifiedGROUP PROVIDER ID
MS00116642Medicaid
ALCH6608OtherRAILROAD GROUP ID