MEDICARE: MR. MARCUS ANTHONY KROHNER M.S

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	101YP2500X	Professional Counselor	PC004696	PA

General Provider Information

NPI Number	:	1417140153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS ANTHONY KROHNER M.S

Provider Business Mailing Address
First Line	:	756 S MILDRED ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19147-2810
Country	:	US
Telephone Number	:	215-627-7292
Fax Number	:

Provider Business Practice Location Address
First Line	:	1760 MARKET ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4134
Country	:	US
Telephone Number	:	215-575-9140
Fax Number	:

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

Provider Enumeration Date	:	08/27/2007
Last Update Date	:	08/27/2007

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