Provider Demographics
NPI:1881627479
Name:SIMARD, MARCELLIN L (MD)
Entity type:Individual
Prefix:
First Name:MARCELLIN
Middle Name:L
Last Name:SIMARD
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 1:2085 S PACHECO ST
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6103
Mailing Address - Country:US
Mailing Address - Phone:505-984-8012
Mailing Address - Fax:505-913-3589
Practice Address - Street 1:2085 S PACHECO ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6103
Practice Address - Country:US
Practice Address - Phone:505-984-8012
Practice Address - Fax:505-913-3589
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20060177207R00000X, 207RC0000X
NMMD2006-0177207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
E33339Medicare UPIN