Provider Demographics
NPI:1861597312
Name:MARC J. MEDWAY MD PC
Entity type:Organization
Organization Name:MARC J. MEDWAY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEDWAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-542-7260
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0602
Mailing Address - Country:US
Mailing Address - Phone:215-542-7260
Mailing Address - Fax:215-542-1012
Practice Address - Street 1:7600 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-3736
Practice Address - Fax:215-728-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020951E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty