Provider Demographics
NPI:1104605542
Name:MARCUS, HAILEY SAMANTHA (PA-C)
Entity type:Individual
Prefix:
First Name:HAILEY
Middle Name:SAMANTHA
Last Name:MARCUS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 WISES MILL RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-3118
Mailing Address - Country:US
Mailing Address - Phone:267-421-4589
Mailing Address - Fax:
Practice Address - Street 1:2 PENN BLVD STE 108
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19144-1402
Practice Address - Country:US
Practice Address - Phone:215-842-0406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA006616208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics