Provider Demographics
NPI:1285647636
Name:MARSHALICK, STEVEN ANDREW (PA-C)
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:ANDREW
Last Name:MARSHALICK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 CARDINAL DR
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-1393
Mailing Address - Country:US
Mailing Address - Phone:610-825-7279
Mailing Address - Fax:
Practice Address - Street 1:1401 BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1904
Practice Address - Country:US
Practice Address - Phone:215-233-1001
Practice Address - Fax:215-233-9749
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000076L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAR06068Medicare UPIN
PA474140JW9Medicare ID - Type Unspecified