1770586687 NPI number — DR. JON L MARBERGER OD

Table of content: DR. JON L MARBERGER OD (NPI 1770586687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770586687 NPI number — DR. JON L MARBERGER OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARBERGER
Provider First Name:
JON
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770586687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 429
Provider Second Line Business Mailing Address:
2256 MT CARMEL AVE
Provider Business Mailing Address City Name:
GLENSIDE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19038-0429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-576-1321
Provider Business Mailing Address Fax Number:
215-886-6892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2256 MOUNT CARMEL AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENSIDE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19038-4610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-576-1321
Provider Business Practice Location Address Fax Number:
215-886-6892
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OEG000871 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 21183407558 . This is a "BEECH STREET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 277623 . This is a "MAMSI" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1957331 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: J48917 . This is a "AMERIHEALTH OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 86526166 . This is a "BCBS OF AL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: EYEMED . This is a "116943" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2263894 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com