Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | DC003760-L | PA |
NPI | 1194767293 |
---|---|
Provider Name | Dr. Stephen C Marini |
First Address | King Of Prussia, PA 19406-2150 |
Second Address | King Of Prussia, PA 19406-2150 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0541982 | (05) | PA |