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General NPI Number Information
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NPI Number | 1174905657
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Entity Type | Individual
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Provider Name | MARILYN IRENE SPAGNOL PA-C
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Gender | Female
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Dates
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Enumeration Date | 06/22/2015
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Last Update Date | 12/23/2021
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Provider Practice Location Address
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Address Line | 5501 OLD YORK RD
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City | PHILADELPHIA
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State | PA
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Zip | 19141-3018
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Country | US
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Telephone | 215-456-6560
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Fax |
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Provider Business Mailing Address
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Address Line | 1616 COUNTY LINE RD
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City | CHALFONT
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State | PA
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Zip | 18914-1201
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Country | US
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Telephone | 215-589-0262
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA057625
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00371600
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License Number State | NJ
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