Provider Demographics
NPI:1386639698
Name:MARCINCIN, PAUL GERARD (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GERARD
Last Name:MARCINCIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2597 SCHOENERSVILLE RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-7325
Mailing Address - Country:US
Mailing Address - Phone:610-861-7727
Mailing Address - Fax:610-861-2995
Practice Address - Street 1:2597 SCHOENERSVILLE RD
Practice Address - Street 2:SUITE 303
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7325
Practice Address - Country:US
Practice Address - Phone:610-861-7727
Practice Address - Fax:610-861-2995
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040755E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
55701OtherAETNA ID NUMBER
515265OtherHIGMARK BLUE SHIELD
01033101OtherCAPITOL BLUE CROSS
PA990714OtherKEYSTONE CENTRAL ID
55701OtherAETNA ID NUMBER
515265OtherHIGMARK BLUE SHIELD