Provider Demographics
NPI:1275552994
Name:BOBIK, J MARC (DPM)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:MARC
Last Name:BOBIK
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 1:129 STATE RD
Mailing Address - Street 2:
Mailing Address - City:WEST GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19390-8905
Mailing Address - Country:US
Mailing Address - Phone:610-869-2280
Mailing Address - Fax:
Practice Address - Street 1:129 STATE RD
Practice Address - Street 2:
Practice Address - City:WEST GROVE
Practice Address - State:PA
Practice Address - Zip Code:19390-8905
Practice Address - Country:US
Practice Address - Phone:610-869-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC001991L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000317Medicare ID - Type Unspecified
PAT72351Medicare UPIN