Provider Demographics
NPI:1932185329
Name:MARCHIANDO, ALBERT W (MD)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:W
Last Name:MARCHIANDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1025 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:IL
Mailing Address - Zip Code:62301-4038
Mailing Address - Country:US
Mailing Address - Phone:217-222-6550
Mailing Address - Fax:217-277-2253
Practice Address - Street 1:1107 COLLEGE AVE
Practice Address - Street 2:STE 2
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-2664
Practice Address - Country:US
Practice Address - Phone:217-222-6550
Practice Address - Fax:217-228-2657
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORID29207Y00000X
IL036059407207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL634650025Medicare PIN
A11057Medicare UPIN