Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD432764 | PA |
NPI | 1114975984 |
---|---|
Provider Name | Mark L Marbey |
First Address | Erie, PA 16502-4602 |
Second Address | Erie, PA 16502-4602 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 20/09/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D07154 | (02) |