Connelly, Marcus George

Connelly, Marcus George is an individual health care provider with primary practice located at 600 Coffee Rd , Modesto CA 95355-4201. He recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as his primary health care specialty. Connelly, Marcus George can be contacted via phone (209) 521-6097.

Contact Information

Primary practice address
600 Coffee Rd Modesto CA 95355-4201
Phone: (209) 521-6097
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X C50251 California

Profile Details

NPI number 1295703577
LBN Legal business name Connelly, Marcus George
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 10th, 2006
Last updated Nov 1st, 2016 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295703577 NPPES
California MEDICAID 00C502510

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