Provider Demographics
NPI:1396745840
Name:WERTLIEB, MARCIE OSER (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIE
Middle Name:OSER
Last Name:WERTLIEB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14201 LAUREL PARK DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5203
Mailing Address - Country:US
Mailing Address - Phone:301-498-6616
Mailing Address - Fax:301-498-8030
Practice Address - Street 1:14201 LAUREL PARK DR
Practice Address - Street 2:SUITE 208
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5203
Practice Address - Country:US
Practice Address - Phone:301-498-6616
Practice Address - Fax:301-498-8030
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00062700207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I31938Medicare UPIN
00SNL511Medicare ID - Type Unspecified