Provider Demographics
NPI:1861785537
Name:TERESA A. MARLINO M.D., LLC
Entity type:Organization
Organization Name:TERESA A. MARLINO M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARLINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-647-5111
Mailing Address - Street 1:255 W LANCASTER AVE
Mailing Address - Street 2:SUITE 222 PAOLI MEDICAL BUILDING II
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:610-647-5111
Mailing Address - Fax:610-293-5113
Practice Address - Street 1:255 W LANCASTER AVE
Practice Address - Street 2:SUITE 222 PAOLI MEDICAL BUILDING II
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1763
Practice Address - Country:US
Practice Address - Phone:610-647-5111
Practice Address - Fax:610-293-1068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-27
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD067271L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty