Provider Demographics
NPI:1861672800
Name:MARVIN L ENGEL MD INC
Entity Type:Organization
Organization Name:MARVIN L ENGEL MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:LEROY
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-939-9303
Mailing Address - Street 1:130 LA CASA VIA
Mailing Address - Street 2:BLDG 2 SUITE 110
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3045
Mailing Address - Country:US
Mailing Address - Phone:925-939-9303
Mailing Address - Fax:925-939-7518
Practice Address - Street 1:130 LA CASA VIA
Practice Address - Street 2:BLDG 2 SUITE 110
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3045
Practice Address - Country:US
Practice Address - Phone:925-939-9303
Practice Address - Fax:925-939-7518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA019111207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A21598Medicare UPIN
CA00A191110Medicare PIN