MEDICARE: MARCIE E MACOLINO M.D.

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	208000000X	Pediatrics Physician	MD057889L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1090409	OTHER	PA	KEY MERCY PROVIDER ID
2	0055732001	OTHER	PA	IBC PROVIDER NUMBER
3	01600250	OTHER	PA	MEDICAL ASSISTANCE
4	582735	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1346240116
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIE E MACOLINO M.D.

Provider Business Mailing Address
First Line	:	7056 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1826
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

Provider Business Practice Location Address
First Line	:	7056 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19119-1826
Country	:	US
Telephone Number	:	215-247-2996
Fax Number	:	215-247-7504

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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Directions to “ MARCIE E MACOLINO M.D.” Practice Location

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