Provider Demographics
NPI:1346214798
Name:GENDELMAN, MARLA S (MD)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:S
Last Name:GENDELMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5461 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1901
Mailing Address - Country:US
Mailing Address - Phone:412-422-1448
Mailing Address - Fax:
Practice Address - Street 1:400 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:BRADDOCK
Practice Address - State:PA
Practice Address - Zip Code:15104-1599
Practice Address - Country:US
Practice Address - Phone:412-636-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043968L207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE86295Medicare UPIN
PA672665Medicare ID - Type Unspecified