MEDICARE: MITCHELL JASON MARDER D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS009943L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285673319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL JASON MARDER D.O.

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-673-1520
Fax Number	:	215-673-1980

Provider Business Practice Location Address
First Line	:	9331 OLD BUSTLETON AVE
Second Line	:	SUITE 101
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4204
Country	:	US
Telephone Number	:	215-673-1520
Fax Number	:	215-673-1980

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2006
Last Update Date	:	12/16/2013

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