Provider Demographics
NPI:1770563728
Name:MARLEY, WAYNE M (MD)
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:M
Last Name:MARLEY
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 1:1950 STREET RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3755
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1950 STREET RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3755
Practice Address - Country:US
Practice Address - Phone:215-639-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031644E207ND0101X, 207ND0900X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMA163713Medicare ID - Type Unspecified
PAB40424Medicare UPIN