Provider Demographics
NPI:1255414207
Name:ALBORNOZ, MARCO A (MD)
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:A
Last Name:ALBORNOZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1088 W BALTIMORE PIKE STE 2105
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-5136
Mailing Address - Country:US
Mailing Address - Phone:610-565-2415
Mailing Address - Fax:484-444-0111
Practice Address - Street 1:1088 W BALTIMORE PIKE STE 2105
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-5136
Practice Address - Country:US
Practice Address - Phone:610-237-5801
Practice Address - Fax:610-237-5802
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD040031L207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011646990003Medicaid
PA0011646990003Medicaid
058192Medicare ID - Type Unspecified