Provider Demographics
NPI:1760474183
Name:MARMOL, AIMEE KOPNICKY (MD)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:KOPNICKY
Last Name:MARMOL
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 1:2000 OXFORD DR
Mailing Address - Street 2:420
Mailing Address - City:BETHEL PARK
Mailing Address - State:PA
Mailing Address - Zip Code:15102-1827
Mailing Address - Country:US
Mailing Address - Phone:412-942-8500
Mailing Address - Fax:412-942-8519
Practice Address - Street 1:2000 OXFORD DR
Practice Address - Street 2:420
Practice Address - City:BETHEL PARK
Practice Address - State:PA
Practice Address - Zip Code:15102-1827
Practice Address - Country:US
Practice Address - Phone:412-942-8500
Practice Address - Fax:412-942-8519
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068104L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG90388Medicare UPIN
026182PNEMedicare PIN