Provider Demographics
NPI:1376557330
Name:MARVIN, ANDREA L (MD)
Entity Type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:L
Last Name:MARVIN
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 1:9 HALSEY DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-2239
Mailing Address - Country:US
Mailing Address - Phone:302-661-1100
Mailing Address - Fax:
Practice Address - Street 1:4512 KIRKWOOD HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5123
Practice Address - Country:US
Practice Address - Phone:302-633-6338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0007766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039099Medicaid