Provider Demographics
NPI:1427245810
Name:MARCELLO, ALTON (MD)
Entity type:Individual
Prefix:
First Name:ALTON
Middle Name:
Last Name:MARCELLO
Suffix:
Gender:M
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:PO BOX 961426
Mailing Address - Street 2:ALTON MARCELLO, MD PA
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79996-1426
Mailing Address - Country:US
Mailing Address - Phone:915-203-6668
Mailing Address - Fax:915-203-6668
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-28
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5221207V00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2104259Medicaid
TX8F23322Medicare PIN