Provider Demographics
NPI:1881923829
Name:ILIES, MARIUS S (M ED)
Entity type:Individual
Prefix:
First Name:MARIUS
Middle Name:S
Last Name:ILIES
Suffix:
Gender:M
Credentials:M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1216 OLD GULPH RD
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1650
Mailing Address - Country:US
Mailing Address - Phone:610-937-7368
Mailing Address - Fax:
Practice Address - Street 1:1216 OLD GULPH RD
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-1650
Practice Address - Country:US
Practice Address - Phone:610-937-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-22
Last Update Date:2009-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst