1346240116 NPI number — MARCIE E MACOLINO M.D.

Table of content: MARCIE E MACOLINO M.D. (NPI 1346240116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346240116 NPI number — MARCIE E MACOLINO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACOLINO
Provider First Name:
MARCIE
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1346240116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7056 GERMANTOWN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19119-1826
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-247-2996
Provider Business Mailing Address Fax Number:
215-247-7504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7056 GERMANTOWN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19119-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-247-2996
Provider Business Practice Location Address Fax Number:
215-247-7504
Provider Enumeration Date:
07/22/2005

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: 208000000X , with the licence number:  MD057889L , 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: 1090409 . This is a "KEY MERCY PROVIDER ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0055732001 . This is a "IBC PROVIDER NUMBER" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 01600250 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 582735 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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