Provider Demographics
NPI:1689780033
Name:THE MARLOWE INSTITUTE
Entity Type:Organization
Organization Name:THE MARLOWE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MARLOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-906-6900
Mailing Address - Street 1:28049 SMYTH DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4023
Mailing Address - Country:US
Mailing Address - Phone:818-906-6900
Mailing Address - Fax:818-906-6903
Practice Address - Street 1:15477 VENTURA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3006
Practice Address - Country:US
Practice Address - Phone:818-906-6900
Practice Address - Fax:818-906-6903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0673892081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG95093Medicare UPIN