Provider Demographics
NPI:1528287851
Name:MADERA, MARCELLA (MD)
Entity type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:MADERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARCELLA
Other - Middle Name:
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3000 N IH 35 STE 600
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1850
Mailing Address - Country:US
Mailing Address - Phone:512-306-1323
Mailing Address - Fax:
Practice Address - Street 1:5656 BEE CAVES RD BLDG C STE. 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-212-4865
Practice Address - Fax:737-220-2520
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9735207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery