Provider Demographics
NPI:1174522320
Name:MARCOWITZ, DAVID HAROLD (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:HAROLD
Last Name:MARCOWITZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1200 N 7TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHARITON
Mailing Address - State:IA
Mailing Address - Zip Code:50049-1210
Mailing Address - Country:US
Mailing Address - Phone:641-774-8103
Mailing Address - Fax:641-774-8087
Practice Address - Street 1:1200 N 7TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:CHARITON
Practice Address - State:IA
Practice Address - Zip Code:50049-1210
Practice Address - Country:US
Practice Address - Phone:641-774-8103
Practice Address - Fax:641-774-8087
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082773207Q00000X
IA3281207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082773Medicaid
IA1174522320OtherWELLMARK
IA1174522320Medicaid
IL08132007OtherBLUE CROSS BLUE SHIELD
IA1174522320OtherWELLMARK
ILF29380Medicare UPIN
IL08132007OtherBLUE CROSS BLUE SHIELD