Provider Demographics
NPI:1285721241
Name:MARSELLA, GREGORY Q (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:Q
Last Name:MARSELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3648 MYKONOS CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-1295
Mailing Address - Country:US
Mailing Address - Phone:561-789-9922
Mailing Address - Fax:561-210-1371
Practice Address - Street 1:8000 N FEDERAL HWY STE 110
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-1681
Practice Address - Country:US
Practice Address - Phone:561-394-2532
Practice Address - Fax:561-210-1371
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME512612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376683700Medicaid
FL04790OtherMEDICARE PTAN
FL04790AOtherMEDICARE PTAN
FL376683700Medicaid
FL04790OtherMEDICARE PTAN
FL04790Medicare PIN