Provider Demographics
NPI:1992703516
Name:AUSTIN, MARIETTE (MD)
Entity type:Individual
Prefix:
First Name:MARIETTE
Middle Name:
Last Name:AUSTIN
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:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:2003 FAIRVIEW AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18042-3915
Practice Address - Country:US
Practice Address - Phone:484-821-1373
Practice Address - Fax:484-821-1375
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2019-07-31
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-23
Provider Licenses
StateLicense IDTaxonomies
PAMD040080E207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA830005526OtherRAILROAD MEDICARE
PA02910700OtherCAPITAL
PAP706303OtherOXFORD
PA6448826006OtherCIGNA
PA807243OtherHIGHMARK BLUE SHIELD
PA2180299OtherAETNA
PAP706303OtherOXFORD