Provider Demographics
NPI:1265509905
Name:MARDER MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:MARDER MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-332-0605
Mailing Address - Street 1:8350 ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2531
Mailing Address - Country:US
Mailing Address - Phone:215-332-0605
Mailing Address - Fax:215-332-1156
Practice Address - Street 1:8350 ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2531
Practice Address - Country:US
Practice Address - Phone:215-332-0605
Practice Address - Fax:215-332-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009943L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA07748069Medicaid
PA07748069Medicaid
PAH27471Medicare UPIN