Provider Demographics
NPI:1548436744
Name:CHRIS MARUKOS DPM
Entity type:Organization
Organization Name:CHRIS MARUKOS DPM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MARUKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:215-464-3600
Mailing Address - Street 1:8410 BUSTLETON AVE
Mailing Address - Street 2:STE 3
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-1924
Mailing Address - Country:US
Mailing Address - Phone:215-464-3600
Mailing Address - Fax:
Practice Address - Street 1:8410 BUSTLETON AVE
Practice Address - Street 2:STE 3
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-1924
Practice Address - Country:US
Practice Address - Phone:215-464-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003264L332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001134493Medicaid
PA001134493Medicaid
PA5233720001Medicare NSC
T30377Medicare UPIN