Provider Demographics
NPI:1528168531
Name:MARCELO B. CORPUZ JR MD PC
Entity type:Organization
Organization Name:MARCELO B. CORPUZ JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELO
Authorized Official - Middle Name:B
Authorized Official - Last Name:CORPUZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:412-381-2599
Mailing Address - Street 1:2018 E CARSON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-1949
Mailing Address - Country:US
Mailing Address - Phone:412-381-2599
Mailing Address - Fax:412-381-9282
Practice Address - Street 1:2018 E CARSON ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-1949
Practice Address - Country:US
Practice Address - Phone:412-381-2599
Practice Address - Fax:412-381-9282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033835L207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0778066Medicaid
PA0778066Medicaid
PAB37365Medicare UPIN