Individual
LUIS B MARRERO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
23 KENNEDY ST, SUITE 302, BRADFORD, PA 16701-2005
(814) 362-9804
(814) 362-6571
Mailing address
7 ACEE DRIVE, NATRONA HEIGHTS, PA 15065
(800) 223-5544
(724) 294-3206
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
MD035910E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0010502400004
—
PA
01
—
1011278940001
MEDICAL ASST
—
01
—
1624770
HIGHMARK GROUP KEYSTONE
—
01
—
197611
BLUESHIELD
—
01
—
20118561300
BUREAU OF WIC GROUP
OH
01
—
352438
HEALTH AMERICA
—
01
—
MD035910E
PA LICENSE
—
Enumeration date
06/07/2006
Last updated
09/10/2007
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