Healthcare Provider Details

I. General information

NPI: 1295750578
Provider Name (Legal Business Name): VIJAY R MARWAHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 ROUTE 73 S STE 309
MARLTON NJ
08053-4141
US

IV. Provider business mailing address

750 ROUTE 73 S STE 309A
MARLTON NJ
08053-4191
US

V. Phone/Fax

Practice location:
  • Phone: 856-872-3636
  • Fax: 856-872-3606
Mailing address:
  • Phone: 856-872-3636
  • Fax: 856-872-3606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101232797
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08624500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD449336
License Number StatePA
# 4
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD449336
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: