Provider Demographics
NPI:1841295706
Name:MCLARTY, MARCELLA RUTH (MD)
Entity type:Individual
Prefix:DR
First Name:MARCELLA
Middle Name:RUTH
Last Name:MCLARTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1045
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95927-1045
Mailing Address - Country:US
Mailing Address - Phone:530-809-2154
Mailing Address - Fax:530-965-5508
Practice Address - Street 1:2485 NOTRE DAME BLVD
Practice Address - Street 2:SUITE 370-16
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928
Practice Address - Country:US
Practice Address - Phone:530-809-2154
Practice Address - Fax:530-965-5598
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69923208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00135617OtherMEDICARE RAILROAD #
CA00G699230Medicaid
CAG69923OtherCA MEDICAL LICENSE
WA61148980OtherWA STATE MEDICAL LICENSE
WA61148980OtherWA STATE MEDICAL LICENSE
CABM2837752OtherDEA