Provider Demographics
NPI:1346810298
Name:LOBDELL, MARLON J
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:J
Last Name:LOBDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9917 GLENBRIDGE WAY APT 524
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-4325
Mailing Address - Country:US
Mailing Address - Phone:315-256-3197
Mailing Address - Fax:
Practice Address - Street 1:9917 GLENBRIDGE WAY APT 524
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4325
Practice Address - Country:US
Practice Address - Phone:315-256-3197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2021-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172A00000XOther Service ProvidersDriverGroup - Single Specialty