Provider Demographics
NPI:1720166127
Name:DOOKHAN, MARLENE J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:J
Last Name:DOOKHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 W SPROUL RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SPRINGFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:19064-2045
Mailing Address - Country:US
Mailing Address - Phone:302-477-9660
Mailing Address - Fax:302-477-9495
Practice Address - Street 1:196 W SPROUL RD
Practice Address - Street 2:SUITE 208
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2045
Practice Address - Country:US
Practice Address - Phone:302-477-9660
Practice Address - Fax:302-477-9495
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD051135L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001462645Medicaid
PA001462645Medicaid
PAF85302Medicare UPIN