Individual
STACIE MICHEEL MARRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1505 W SHERMAN AVE, VINELAND, NJ 08360-7059
(856) 845-0100
Mailing address
PO BOX 191, ROCKLAND, DE 19732-0191
(302) 651-4200
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD053971L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015178970006
—
PA
01
—
50053515
CAPITAL
—
01
—
723351
HIGHMARK/FREEDOM BLUE
—
01
—
P006966
GATEWAY
—
Enumeration date
07/03/2006
Last updated
04/12/2022
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