Provider Demographics
NPI:1053835264
Name:MARCELIN, MARVIN (DPM)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:MARCELIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CARTERS MILL RD
Mailing Address - Street 2:
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-2702
Mailing Address - Country:US
Mailing Address - Phone:954-319-2196
Mailing Address - Fax:
Practice Address - Street 1:5735 RIDGE AVE STE 208
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19128-1747
Practice Address - Country:US
Practice Address - Phone:215-487-4284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-29
Last Update Date:2019-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006879213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist