MEDICARE: MARC ALAN LANDSBERG MD

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1649785619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARC ALAN LANDSBERG MD

Provider Business Mailing Address
First Line	:	1094 WELSH RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2805
Country	:	US
Telephone Number	:	215-677-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1094 WELSH RD
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-2805
Country	:	US
Telephone Number	:	215-677-6000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. MARC ALAN LANDSBERG
Credential	:	MD
Telephone Number	:	215-677-6000

Provider Enumeration Date	:	12/12/2017
Last Update Date	:	12/12/2017

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