Provider Demographics
NPI:1902804289
Name:ENGEL, MARVIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:L
Last Name:ENGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:L
Other - Last Name:ENGEL, MD, INC.
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:169 REQUA RD
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94611-4037
Mailing Address - Country:US
Mailing Address - Phone:510-547-2975
Mailing Address - Fax:510-658-1651
Practice Address - Street 1:2255 YGNACIO VALLEY RD
Practice Address - Street 2:B1
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3343
Practice Address - Country:US
Practice Address - Phone:925-945-7005
Practice Address - Fax:925-945-7084
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA019111207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A191110Medicare ID - Type Unspecified
CAA21598Medicare UPIN