Provider Demographics
NPI:1811086523
Name:MARX, MARVIN H (MD)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:H
Last Name:MARX
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 1:506 N BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-2416
Mailing Address - Country:US
Mailing Address - Phone:215-362-5633
Mailing Address - Fax:215-361-3494
Practice Address - Street 1:506 N BROAD STREET
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-2416
Practice Address - Country:US
Practice Address - Phone:215-362-5633
Practice Address - Fax:215-361-3494
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD007170E208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
51493OtherAETNA
PA0655226Medicaid
PA0045552000OtherPERSONAL CHOICE
PA0045552000OtherKEYSTONE
PA0045552000OtherPERSONAL CHOICE
E55380Medicare UPIN