Provider Demographics
NPI:1528306164
Name:MARCUS, I. DAVID (PHD)
Entity type:Individual
Prefix:DR
First Name:I.
Middle Name:DAVID
Last Name:MARCUS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 W HEDDING ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-1245
Mailing Address - Country:US
Mailing Address - Phone:408-313-3365
Mailing Address - Fax:408-248-9753
Practice Address - Street 1:1022 W HEDDING ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1245
Practice Address - Country:US
Practice Address - Phone:408-313-3365
Practice Address - Fax:408-248-9753
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16216103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist