Provider Demographics
NPI:1801906532
Name:MARBACH, ROBERT J (PAC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:MARBACH
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1177 HIGHWAY 315 BLVD
Mailing Address - Street 2:DOLPHIN PLAZA
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6928
Mailing Address - Country:US
Mailing Address - Phone:570-270-5713
Mailing Address - Fax:570-270-5719
Practice Address - Street 1:1177 HIGHWAY 315 BLVD
Practice Address - Street 2:DOLPHIN PLAZA
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6928
Practice Address - Country:US
Practice Address - Phone:570-270-5713
Practice Address - Fax:570-270-5719
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOA002648363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ72740Medicare UPIN
PA104494Medicare PIN