Individual
MARCIE E MACOLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7056 GERMANTOWN AVE, PHILADELPHIA, PA 19119-1826
(215) 247-2996
(215) 247-7504
Mailing address
7056 GERMANTOWN AVE, PHILADELPHIA, PA 19119-1826
(215) 247-2996
(215) 247-7504
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD057889L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0055732001
IBC PROVIDER NUMBER
PA
01
—
01600250
MEDICAL ASSISTANCE
PA
01
—
1090409
KEY MERCY PROVIDER ID
PA
01
—
582735
AETNA
PA
Enumeration date
07/22/2005
Last updated
07/08/2007
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