Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | MD456635 | PA |
N | 208200000X | Surgeon | 40501 | KY |
N | 208600000X | Surgeon | 40501 | KY |
N | 208200000X | Surgeon | MD456635 | PA |
N | 208600000X | Surgeon | MD456635 | PA |
NPI | 1265455406 |
---|---|
Provider Name | Dr. Michael R Marvin |
First Address | Danville, PA 17822-4903 |
Second Address | Danville, PA 17822-1348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 31/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200862650 | (05) | IN |
2833136000 | PASSPORT ADVANTAGE (01) | KY |
50014427 | PASSPORT (01) | KY |
64130560 | (05) | KY |
H68227 | (02) | KY |
MA467930 | MEDICARE (01) | PA |