Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD021353E | PA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD021353E | PA |
NPI | 1104829068 |
---|---|
Provider Name | Roger A. Marinchak |
First Address | Philadelphia, PA 19114-1028 |
Second Address | Jenkintown, PA 19046-3724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 07/09/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009912920018 | (05) | PA |
B35418 | (02) | PA |