Provider Demographics
NPI:1679660799
Name:WILLS, MARCIA L (MD)
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:WILLS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 745745
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-5745
Mailing Address - Country:US
Mailing Address - Phone:603-433-4907
Mailing Address - Fax:603-433-4910
Practice Address - Street 1:333 BORTHWICK AVE DEPT OF
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-7128
Practice Address - Country:US
Practice Address - Phone:603-433-4907
Practice Address - Fax:603-433-4910
Is Sole Proprietor?:No
Enumeration Date:2006-10-09
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ME018544207ZP0102X
VT042.0013462207ZP0102X
NH33230207ZP0102X
TNMD39313207ZP0102X
MA244652207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G73578Medicare UPIN