Provider Demographics
NPI:1902830912
Name:MARENBERG, MARJORIE E (MD)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:E
Last Name:MARENBERG
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 1:30 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-3322
Mailing Address - Country:US
Mailing Address - Phone:610-688-3635
Mailing Address - Fax:
Practice Address - Street 1:30 WEST AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3322
Practice Address - Country:US
Practice Address - Phone:484-476-8510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD068850L207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA23-3090763OtherGROUP TAX ID
PA001826293Medicaid
NJ8391408Medicaid
PA001826293Medicaid
PA044300Medicare PIN