Healthcare Provider Details

I. General information

NPI: 1285647636
Provider Name (Legal Business Name): STEVEN ANDREW MARSHALICK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 BETHLEHEM PIKE
FLOURTOWN PA
19031-1904
US

IV. Provider business mailing address

228 CARDINAL DR
CONSHOHOCKEN PA
19428-1393
US

V. Phone/Fax

Practice location:
  • Phone: 215-233-1001
  • Fax: 215-233-9749
Mailing address:
  • Phone: 610-825-7279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA000076L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: