Provider Demographics
NPI:1730140864
Name:MARCOUX, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MARCOUX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 EAST AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-5299
Mailing Address - Country:US
Mailing Address - Phone:401-725-4739
Mailing Address - Fax:401-725-4740
Practice Address - Street 1:407 EAST AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-5299
Practice Address - Country:US
Practice Address - Phone:401-725-4739
Practice Address - Fax:401-725-4740
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD7976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
5117244OtherAETNA
04-07275OtherUNITEDHEALTHCARE
1730140864OtherCHAMPUS
RI21726-4OtherBLUE SHIELD OF RI ID#
406226OtherTUFTS
RI202696OtherBLUE CHIP OF RHODE ISLAND
AA34962OtherHARVARD PILGRIM HEALTH CARE
2973OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
RI7002341Medicaid
2973OtherNEIGHBORHOOD HEALTH PLAN OF RHODE ISLAND
406226OtherTUFTS