Healthcare Provider Details

I. General information

NPI: 1386846806
Provider Name (Legal Business Name): MARISA GEFEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MARISA BASHKIN

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 S 40TH ST
PHILADELPHIA PA
19104-3042
US

IV. Provider business mailing address

PO BOX 746722
ATLANTA GA
30374-6722
US

V. Phone/Fax

Practice location:
  • Phone: 215-444-7470
  • Fax: 215-764-6556
Mailing address:
  • Phone: 312-733-9730
  • Fax: 773-866-8014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD439866
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: