Healthcare Provider Details

I. General information

NPI: 1770582900
Provider Name (Legal Business Name): MARC ALAN LANDSBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1094 WELSH RD
PHILADELPHIA PA
19115-2805
US

IV. Provider business mailing address

1094 WELSH RD
PHILADELPHIA PA
19115-2805
US

V. Phone/Fax

Practice location:
  • Phone: 215-677-6000
  • Fax:
Mailing address:
  • Phone: 215-677-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD036563L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number25MA03224200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: