Provider Demographics
NPI:1760930549
Name:MARENCIN, GARY (AUD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:MARENCIN
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 OGLETOWN-STANTON ROAD
Mailing Address - Street 2:MEDICAL ARTS PAVILION 2, SUITE 1205
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713
Mailing Address - Country:US
Mailing Address - Phone:302-623-4050
Mailing Address - Fax:302-623-4059
Practice Address - Street 1:4735 OGLETOWN-STANTON ROAD
Practice Address - Street 2:MEDICAL ARTS PAVILION 2, SUITE 1205
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-623-4050
Practice Address - Fax:302-623-4059
Is Sole Proprietor?:No
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE02-0000045231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist