Provider Demographics
NPI:1033219795
Name:LIM, MARIE BLANCHE (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:BLANCHE
Last Name:LIM
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:235 N BROAD ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1511
Mailing Address - Country:US
Mailing Address - Phone:215-762-7785
Mailing Address - Fax:215-568-6007
Practice Address - Street 1:227 N BROAD ST STE 301
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-1503
Practice Address - Country:US
Practice Address - Phone:215-762-7785
Practice Address - Fax:215-568-6007
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2022-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD020122E207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000761050Medicaid
PALI091337Medicare ID - Type Unspecified
A78368Medicare UPIN