Provider Demographics
NPI:1891791117
Name:HELMOLD, MARIE E (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:E
Last Name:HELMOLD
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 1:1665 VALLEY CENTER PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-2353
Mailing Address - Country:US
Mailing Address - Phone:610-868-3150
Mailing Address - Fax:610-868-3156
Practice Address - Street 1:1665 VALLEY CENTER PKWY STE 120
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-2353
Practice Address - Country:US
Practice Address - Phone:610-868-3150
Practice Address - Fax:610-868-3156
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD055215L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAG11882Medicare UPIN
PA783416GGGMedicare ID - Type Unspecified