Healthcare Provider Details

I. General information

NPI: 1720166127
Provider Name (Legal Business Name): MARLENE J DOOKHAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 W SPROUL RD SUITE 208
SPRINGFIELD PA
19064-2045
US

IV. Provider business mailing address

196 W SPROUL RD SUITE 208
SPRINGFIELD PA
19064-2045
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-9660
  • Fax: 302-477-9495
Mailing address:
  • Phone: 302-477-9660
  • Fax: 302-477-9495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD051135L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: