Provider Demographics
NPI:1194825679
Name:COLVIN, MARIANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:
Last Name:COLVIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6826 TORRESDALE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-2314
Mailing Address - Country:US
Mailing Address - Phone:215-335-1110
Mailing Address - Fax:
Practice Address - Street 1:6826 TORRESDALE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-2314
Practice Address - Country:US
Practice Address - Phone:215-335-1110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007150L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE97598Medicare UPIN
PA686457Medicare ID - Type Unspecified