Provider Demographics
NPI:1669518189
Name:FRED S MARCUS, M.D. A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:FRED S MARCUS, M.D. A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARCUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-216-8300
Mailing Address - Street 1:2940 WHIPPLE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2857
Mailing Address - Country:US
Mailing Address - Phone:650-216-8300
Mailing Address - Fax:650-216-8400
Practice Address - Street 1:2940 WHIPPLE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2857
Practice Address - Country:US
Practice Address - Phone:650-216-8300
Practice Address - Fax:650-216-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA46101Medicare UPIN
CA00G348140Medicare PIN