Provider Demographics
NPI:1912908955
Name:MARKUSEN, TRICIA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TRICIA
Middle Name:E
Last Name:MARKUSEN
Suffix:
Gender:F
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 1430
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-1430
Mailing Address - Country:US
Mailing Address - Phone:831-649-0175
Mailing Address - Fax:831-646-0220
Practice Address - Street 1:889 PACIFIC ST
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-4463
Practice Address - Country:US
Practice Address - Phone:831-649-0175
Practice Address - Fax:831-646-0220
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64635207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A646350Medicare ID - Type Unspecified
H16406Medicare UPIN