Provider Demographics
NPI:1255393641
Name:MAROON, MICHELE S (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:S
Last Name:MAROON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:16 WOODBINE LANE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:PA
Practice Address - Zip Code:17822-5206
Practice Address - Country:US
Practice Address - Phone:570-271-8050
Practice Address - Fax:570-271-5940
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD039122E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001207437Medicaid
PA001207437Medicaid
E55691Medicare UPIN