Provider Demographics
NPI:1669456596
Name:WILCK, MARISSA B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISSA
Middle Name:B
Last Name:WILCK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:3400 SPRUCE ST.
Mailing Address - Street 2:3 SILVERSTEIN SUITE D
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4206
Mailing Address - Country:US
Mailing Address - Phone:215-662-6932
Mailing Address - Fax:612-662-7899
Practice Address - Street 1:3400 SPRUCE ST.
Practice Address - Street 2:3 SILVERSTEIN BLDG., SUITE D
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4206
Practice Address - Country:US
Practice Address - Phone:215-662-6932
Practice Address - Fax:617-662-7899
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2012-05-29
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Provider Licenses
StateLicense IDTaxonomies
MA225632207RI0200X
PAMD441111207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease