MEDICARE: DR. EMMANUEL MARRERO

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	372600000X	Adult Companion	38643601	PA
2	374U00000X	Home Health Aide	38643601	PA

General Provider Information

NPI Number	:	1467010389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUEL MARRERO

Provider Business Mailing Address
First Line	:	6339 ALGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5802
Country	:	US
Telephone Number	:	267-815-8544
Fax Number	:

Provider Business Practice Location Address
First Line	:	6339 ALGON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-5802
Country	:	US
Telephone Number	:	267-388-7434
Fax Number	:

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

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	06/05/2019

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