Provider Demographics
NPI:1184302556
Name:NAGELBERG, MARIN (OD)
Entity type:Individual
Prefix:DR
First Name:MARIN
Middle Name:
Last Name:NAGELBERG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1930 S BROAD ST UNIT 9
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-2328
Mailing Address - Country:US
Mailing Address - Phone:800-448-6767
Mailing Address - Fax:215-339-8103
Practice Address - Street 1:1930 S BROAD ST UNIT 9
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2328
Practice Address - Country:US
Practice Address - Phone:800-448-6767
Practice Address - Fax:215-339-8103
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046011755152W00000X
PAOEG004132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist