MEDICARE: DR. LOUIS R MARION DMD MS

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	1223P0700X	Prosthodontics	DS029497L	PA

General Provider Information

NPI Number	:	1962660258
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOUIS R MARION DMD MS

Provider Business Mailing Address
First Line	:	1500 LOCUST ST
Second Line	:	SUITE 1416
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4329
Country	:	US
Telephone Number	:	215-732-5110
Fax Number	:	215-732-9938

Provider Business Practice Location Address
First Line	:	1500 LOCUST STREET
Second Line	:	SUITE 1416
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-4314
Country	:	US
Telephone Number	:	215-732-5110
Fax Number	:

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

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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