Individual
MICHAEL JOSEPH MARCELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
111 ACADIA DR., RACELAND, LA 70394
(985) 537-7575
Mailing address
1514 JEFFERSON HWY, NEW ORLEANS, LA 70121-2429
(504) 842-4000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
013251
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04183560
—
MS
01
—
080192844
RR MEDICARE
LA
05
—
1164305
—
LA
Enumeration date
07/07/2005
Last updated
10/05/2010
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