Provider Demographics
NPI:1518907880
Name:MARRERO, LUIS B (MD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:B
Last Name:MARRERO
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 1:7 ACEE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065
Mailing Address - Country:US
Mailing Address - Phone:800-223-5544
Mailing Address - Fax:724-294-3206
Practice Address - Street 1:23 KENNEDY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2005
Practice Address - Country:US
Practice Address - Phone:814-362-9804
Practice Address - Fax:814-362-6571
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035910E207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1011278940001OtherMEDICAL ASST
197611OtherBLUESHIELD
1624770OtherHIGHMARK GROUP KEYSTONE
MD035910EOtherPA LICENSE
352438OtherHEALTH AMERICA
OH20118561300OtherBUREAU OF WIC GROUP
PA0010502400004Medicaid
352438OtherHEALTH AMERICA
083803Medicare ID - Type UnspecifiedGROUP
MD035910EOtherPA LICENSE
1624770OtherHIGHMARK GROUP KEYSTONE