Provider Demographics
NPI:1922327659
Name:TILICH, MARINA (MD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:TILICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2545
Mailing Address - Country:US
Mailing Address - Phone:717-721-4585
Mailing Address - Fax:717-721-4597
Practice Address - Street 1:895 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2545
Practice Address - Country:US
Practice Address - Phone:717-721-4585
Practice Address - Fax:717-721-4597
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD450977207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine