Basic Information
| Provider Information | |||||||||
| NPI: | 1326240409 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARCHELEOVICH | ||||||||
| FirstName: | MARLO | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 329 S PLEASANT AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144458039 | ||||||||
| Practice Location | |||||||||
| Address1: | 229 S KIMBERLY AVE | ||||||||
| Address2: | |||||||||
| City: | SOMERSET | ||||||||
| State: | PA | ||||||||
| PostalCode: | 155012022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8144453575 | ||||||||
| FaxNumber: | 8144458039 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/01/2007 | ||||||||
| LastUpdateDate: | 08/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS013867 | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1021637230001 | 05 | PA | MEDICAID |