Provider Demographics
NPI:1225037443
Name:MARCELLE, DAWN R (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:R
Last Name:MARCELLE
Suffix:
Gender:F
Credentials:MD, MPH
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 66156
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70896-6156
Mailing Address - Country:US
Mailing Address - Phone:225-650-2000
Mailing Address - Fax:225-650-2099
Practice Address - Street 1:3140 FLORIDA BLVD
Practice Address - Street 2:CAPITOL CITY FAMILY HEALTH CENTER
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-650-2000
Practice Address - Fax:225-650-2099
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15402R208D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1192708Medicaid