Healthcare Provider Details

I. General information

NPI: 1245278084
Provider Name (Legal Business Name): ROY G. MARCUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 MEDICAL CENTER BLVD SUITE 303
UPLAND PA
19013-3955
US

IV. Provider business mailing address

30 MEDICAL CENTER BLVD SUITE 303
UPLAND PA
19013-3955
US

V. Phone/Fax

Practice location:
  • Phone: 610-872-8501
  • Fax: 610-872-5188
Mailing address:
  • Phone: 610-872-8501
  • Fax: 610-872-5188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD061386L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: