Provider Demographics
NPI:1023221678
Name:MICHAEL L. MARONE, M. D.
Entity Type:Organization
Organization Name:MICHAEL L. MARONE, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:SOUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-309-9700
Mailing Address - Street 1:707 WHITE HORSE RD
Mailing Address - Street 2:SUITE C105
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2461
Mailing Address - Country:US
Mailing Address - Phone:856-309-9700
Mailing Address - Fax:856-309-9192
Practice Address - Street 1:707 WHITE HORSE RD
Practice Address - Street 2:SUITE C105
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2461
Practice Address - Country:US
Practice Address - Phone:856-309-9700
Practice Address - Fax:856-309-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02358700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2239809Medicaid
NJ2239809Medicaid
NJC53509Medicare UPIN