Provider Demographics
NPI:1487704078
Name:MARLENE J. MASH, M.D., P.C.
Entity type:Organization
Organization Name:MARLENE J. MASH, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:484-351-8268
Mailing Address - Street 1:545 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1349
Mailing Address - Country:US
Mailing Address - Phone:484-351-8268
Mailing Address - Fax:484-351-8275
Practice Address - Street 1:545 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1349
Practice Address - Country:US
Practice Address - Phone:484-351-8268
Practice Address - Fax:484-351-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051378363AM0700X, 363AS0400X
PAMA052739363AM0700X
PAMD030337E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28206Medicare UPIN