Provider Demographics
NPI:1346240116
Name:MACOLINO, MARCIE E (MD)
Entity type:Individual
Prefix:
First Name:MARCIE
Middle Name:E
Last Name:MACOLINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7056 GERMANTOWN AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1826
Mailing Address - Country:US
Mailing Address - Phone:215-247-2996
Mailing Address - Fax:215-247-7504
Practice Address - Street 1:7056 GERMANTOWN AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1826
Practice Address - Country:US
Practice Address - Phone:215-247-2996
Practice Address - Fax:215-247-7504
Is Sole Proprietor?:No
Enumeration Date:2005-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD057889L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1090409OtherKEY MERCY PROVIDER ID
PA0055732001OtherIBC PROVIDER NUMBER
PA01600250OtherMEDICAL ASSISTANCE
PA582735OtherAETNA
PA0055732001OtherIBC PROVIDER NUMBER
PA582735OtherAETNA