Provider Demographics
NPI:1184660292
Name:MARYMOR, NEIL S (MD)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:S
Last Name:MARYMOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:280 MIDDLETOWN BLVD
Mailing Address - Street 2:
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1816
Mailing Address - Country:US
Mailing Address - Phone:267-572-3166
Mailing Address - Fax:267-572-3160
Practice Address - Street 1:280 MIDDLETOWN BLVD
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1816
Practice Address - Country:US
Practice Address - Phone:267-572-3166
Practice Address - Fax:267-572-3160
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD026704-E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C34832Medicare UPIN
532499UAZMedicare ID - Type Unspecified