MEDICARE: JEFFREY J MARON DO PC

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	:	1801069414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY J MARON DO PC

Provider Business Mailing Address
First Line	:	144 SNYDER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2641
Country	:	US
Telephone Number	:	215-732-6744
Fax Number	:

Provider Business Practice Location Address
First Line	:	144 SNYDER AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-2641
Country	:	US
Telephone Number	:	215-732-6744
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	DR. ILENE WARNER-MARON
Credential	:
Telephone Number	:	610-917-0255

Provider Enumeration Date	:	04/04/2008
Last Update Date	:	04/04/2008

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