Healthcare Provider Details

I. General information

NPI: 1992703516
Provider Name (Legal Business Name): MARIETTE AUSTIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date: 03/15/2006
Reactivation Date: 03/23/2006

III. Provider practice location address

2003 FAIRVIEW AVE
EASTON PA
18042-3915
US

IV. Provider business mailing address

PO BOX 783311
PHILADELPHIA PA
19178-3311
US

V. Phone/Fax

Practice location:
  • Phone: 484-821-1373
  • Fax: 484-821-1375
Mailing address:
  • Phone: 484-884-4500
  • Fax: 484-884-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD040080E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: