Healthcare Provider Details

I. General information

NPI: 1396939948
Provider Name (Legal Business Name): PAULA BORLAND MARCINKEVICH AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 07/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 CHESTNUT ST
PHILADELPHIA PA
19107-4216
US

IV. Provider business mailing address

925 CHESTNUT STREET
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-6784
  • Fax: 215-923-4532
Mailing address:
  • Phone: 215-955-6784
  • Fax: 215-923-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number41YA00091800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAT000322L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: