Provider Demographics
NPI:1477711893
Name:MAREK, KRISTIN JOY (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:JOY
Last Name:MAREK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:RODENBACH LANE
Mailing Address - City:BRODHEADSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18322-9900
Mailing Address - Country:US
Mailing Address - Phone:570-992-4208
Mailing Address - Fax:570-992-6117
Practice Address - Street 1:801 OSTRUM ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1000
Practice Address - Country:US
Practice Address - Phone:484-526-6048
Practice Address - Fax:484-526-6500
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100522207Q00000X
VA0101249844207Q00000X
PAMD450566207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003942OtherMEDICARE GROUP