Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | MA03903300 | NJ |
NPI | 1447340179 |
---|---|
Provider Name | Dr. Michael B. Marchildon |
First Address | Rockland, DE 19732-0191 |
Second Address | Voorhees, NJ 08043-4406 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2006 |
Last Update Date | 29/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1176902 | (05) | PA |
3716708 | (05) | NJ |
4881036 | (05) | MD |
C57387 | (02) |