Healthcare Provider Details

I. General information

NPI: 1902804289
Provider Name (Legal Business Name): MARVIN L ENGEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MARVIN L ENGEL, MD, INC. MD

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 07/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2255 YGNACIO VALLEY RD B1
WALNUT CREEK CA
94598-3343
US

IV. Provider business mailing address

169 REQUA RD
PIEDMONT CA
94611-4037
US

V. Phone/Fax

Practice location:
  • Phone: 925-945-7005
  • Fax: 925-945-7084
Mailing address:
  • Phone: 510-547-2975
  • Fax: 510-658-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA019111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: