MEDICARE: ROBERT J MARBACH PAC

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	363AM0700X	Medical Physician Assistant	OA002648	PA

General Provider Information

NPI Number	:	1801906532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J MARBACH PAC

Provider Business Mailing Address
First Line	:	1177 HIGHWAY 315 BLVD
Second Line	:	DOLPHIN PLAZA
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-6928
Country	:	US
Telephone Number	:	570-270-5713
Fax Number	:	570-270-5719

Provider Business Practice Location Address
First Line	:	1177 HIGHWAY 315 BLVD
Second Line	:	DOLPHIN PLAZA
City	:	WILKES BARRE
State	:	PA
Zip	:	18702-6928
Country	:	US
Telephone Number	:	570-270-5713
Fax Number	:	570-270-5719

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	10/03/2012

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Directions to “ ROBERT J MARBACH PAC” Practice Location

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