Provider Demographics
NPI:1255374476
Name:MARLIN, JANE P (PA-C)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:P
Last Name:MARLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 S. DUKE ST.
Mailing Address - Street 2:P.O. BOX 598
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17608-0598
Mailing Address - Country:US
Mailing Address - Phone:717-299-6371
Mailing Address - Fax:717-397-8881
Practice Address - Street 1:625 S DUKE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-4509
Practice Address - Country:US
Practice Address - Phone:717-299-6371
Practice Address - Fax:717-397-8881
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001747L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA038589Medicare ID - Type Unspecified
PAPO8428Medicare UPIN