Basic Information
| Provider Information | |||||||||
| NPI: | 1528287851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MADERA | ||||||||
| FirstName: | MARCELLA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KOCH | ||||||||
| OtherFirstName: | MARCELLA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 3000 N IH 35 STE 600 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787051850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123061323 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5656 BEE CAVES RD BLDG C STE. 101 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122124865 | ||||||||
| FaxNumber: | 7372202520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2007 | ||||||||
| LastUpdateDate: | 03/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | N9735 | TX | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
No ID Information.