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General NPI Number Information
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NPI Number | 1790914331
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Entity Type | Organization
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Legal Business Name | MARYMORBARIATRICSLLC
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Dates
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Enumeration Date | 07/03/2009
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Last Update Date | 07/03/2009
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Provider Practice Location Address
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Address Line | 100 W SPROUL RD SUITE 224
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City | SPRINGFIELD
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State | PA
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Zip | 19064-2033
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Country | US
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Telephone | 610-715-2316
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Fax | 610-353-0878
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Provider Business Mailing Address
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Address Line | 24 OLD COVERED BRIDGE RD
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City | NEWTOWN SQUARE
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State | PA
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Zip | 19073-1202
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Country | US
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Telephone | 610-715-2316
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Fax | 610-353-0878
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | NEIL S MARYMOR
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Credential | MD
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Telephone | 610-715-2316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD026704E
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License Number State | PA
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