Provider Demographics
NPI:1104804814
Name:MARCUZZI, MARY L (MD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:MARCUZZI
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 1:1723 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25701-5317
Mailing Address - Country:US
Mailing Address - Phone:304-523-5023
Mailing Address - Fax:
Practice Address - Street 1:1723 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5317
Practice Address - Country:US
Practice Address - Phone:304-523-5021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19564207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1803384000Medicaid
OH2564407Medicaid
WVP00263543OtherMEDICARE-RR PROVIDER NUMBER
KY64102239Medicaid
WVP00263543OtherMEDICARE-RR PROVIDER NUMBER
WV4162921Medicare PIN