Provider Demographics
NPI:1457577074
Name:JOHN A MARASCALCO, MD, PA
Entity type:Organization
Organization Name:JOHN A MARASCALCO, MD, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARASCALCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-227-4463
Mailing Address - Street 1:1300 SUNSET DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-4086
Mailing Address - Country:US
Mailing Address - Phone:662-227-4463
Mailing Address - Fax:662-226-5257
Practice Address - Street 1:1300 SUNSET DR
Practice Address - Street 2:SUITE A
Practice Address - City:GRENADA
Practice Address - State:MS
Practice Address - Zip Code:38901-4086
Practice Address - Country:US
Practice Address - Phone:662-227-4463
Practice Address - Fax:662-226-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSDB8986Medicare PIN
MSC00963Medicare PIN