Provider Demographics
NPI:1730376435
Name:MCCULLOUGH, MARCIA E (APRN-BC)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:E
Last Name:MCCULLOUGH
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 COLEGATE DR BLDG 3
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-9549
Mailing Address - Country:US
Mailing Address - Phone:740-568-4814
Mailing Address - Fax:740-374-3165
Practice Address - Street 1:807 FARSON ST STE 210
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1068
Practice Address - Country:US
Practice Address - Phone:740-376-5000
Practice Address - Fax:740-376-5002
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.09586363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2822771Medicaid
WV3810010523Medicaid
WV3810010523Medicaid
OH000000541031OtherANTHEM
OH000000699824OtherANTHEM
OH000000699824OtherANTHEM
WV3810010523Medicaid
NP25651Medicare PIN