Healthcare Provider Details

I. General information

NPI: 1316975451
Provider Name (Legal Business Name): MARCIA S BROSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/17/2021
Certification Date: 11/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 KNIGHTS RD FL 3
PHILADELPHIA PA
19114-4200
US

IV. Provider business mailing address

1101 MARKET ST FL 30
PHILADELPHIA PA
19107-2934
US

V. Phone/Fax

Practice location:
  • Phone: 215-890-3030
  • Fax: 215-890-3031
Mailing address:
  • Phone: 215-481-6836
  • Fax: 215-481-5788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD063022L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD063022L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: