MEDICARE: DR. JEFFREY J. MARON DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	OS003134L	PA

General Provider Information

NPI Number	:	1295775963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY J. MARON DO

Provider Business Mailing Address
First Line	:	2 DUNDEE MEWS
Second Line	:
City	:	MEDIA
State	:	PA
Zip	:	19063-1167
Country	:	US
Telephone Number	:	610-325-5701
Fax Number	:	610-325-9197

Provider Business Practice Location Address
First Line	:	144 SNYDER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2641
Country	:	US
Telephone Number	:	215-336-5566
Fax Number	:	215-336-5568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	06/29/2010

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