Provider Demographics
NPI:1033295225
Name:SAGER, MARSHALL HARRIS (DO)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:HARRIS
Last Name:SAGER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 PRESIDENTIAL BLVD
Mailing Address - Street 2:STE C-130
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-1207
Mailing Address - Country:US
Mailing Address - Phone:610-668-2400
Mailing Address - Fax:610-668-3519
Practice Address - Street 1:191 PRESIDENTIAL BLVD
Practice Address - Street 2:STE C-130
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1207
Practice Address - Country:US
Practice Address - Phone:610-668-2400
Practice Address - Fax:610-668-3519
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAK00009171100000X
PAOS002457L208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
E98041Medicare UPIN
41933Medicare ID - Type Unspecified