Provider Demographics
NPI:1891770913
Name:ROTOR-MAKILAN, MARILYN L (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:ROTOR-MAKILAN
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:850 S 5TH STREET
Mailing Address - Street 2:GOOD SHEPHERD PHYSICIAN GROUP 5TH FLOOR BILLING
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103
Mailing Address - Country:US
Mailing Address - Phone:610-778-9297
Mailing Address - Fax:610-778-9270
Practice Address - Street 1:850 S 5TH STREET
Practice Address - Street 2:GOOD SHEPHERD PHYSICIAN GROUP 5TH FLOOR BILLING
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103
Practice Address - Country:US
Practice Address - Phone:610-778-9297
Practice Address - Fax:610-778-9270
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD 031559E208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011257340009Medicaid
B42030Medicare UPIN
PA0011257340009Medicaid