Provider Demographics
NPI:1801069414
Name:JEFFREY J MARON DO PC
Entity type:Organization
Organization Name:JEFFREY J MARON DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILENE
Authorized Official - Middle Name:
Authorized Official - Last Name:WARNER-MARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-917-0255
Mailing Address - Street 1:144 SNYDER AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-2641
Mailing Address - Country:US
Mailing Address - Phone:215-732-6744
Mailing Address - Fax:
Practice Address - Street 1:144 SNYDER AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-2641
Practice Address - Country:US
Practice Address - Phone:215-732-6744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003134L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA098741Medicare PIN