Provider Demographics
NPI:1578091419
Name:EKONOMIDIS, MARILYN ELIAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:ELIAS
Last Name:EKONOMIDIS
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 1:4051 FREEMANSBURG AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-5596
Mailing Address - Country:US
Mailing Address - Phone:484-503-7474
Mailing Address - Fax:
Practice Address - Street 1:4051 FREEMANSBURG AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-5596
Practice Address - Country:US
Practice Address - Phone:484-503-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11047200207V00000X
PAMD473492207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology