Provider Demographics
NPI:1023176484
Name:ANGERT, MARJORIE (DO)
Entity type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:ANGERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 HAMILTON ST
Mailing Address - Street 2:D-14
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3889
Mailing Address - Country:US
Mailing Address - Phone:215-627-9899
Mailing Address - Fax:
Practice Address - Street 1:1101 MARKET ST
Practice Address - Street 2:9TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2934
Practice Address - Country:US
Practice Address - Phone:215-685-5261
Practice Address - Fax:215-685-5257
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002533L207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01063239Medicaid
PAAN043021Medicare ID - Type UnspecifiedPROVIDER NUMBER
PA01063239Medicaid