Provider Demographics
NPI:1396076402
Name:DECOU, MARCY (DO)
Entity type:Individual
Prefix:DR
First Name:MARCY
Middle Name:
Last Name:DECOU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S MORTON AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2107
Mailing Address - Country:US
Mailing Address - Phone:610-328-0880
Mailing Address - Fax:
Practice Address - Street 1:409 S MORTON AVE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19070-2107
Practice Address - Country:US
Practice Address - Phone:610-328-0880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005468L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology