Provider Demographics
NPI:1043253271
Name:KNAUB, MARILYN ADELE (MD)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:ADELE
Last Name:KNAUB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:ADELE
Other - Last Name:BAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:29 N 3RD ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363-1423
Practice Address - Country:US
Practice Address - Phone:610-932-6386
Practice Address - Fax:610-932-6385
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD023876E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP002614OtherGATEWAY HEALTH PLAN
PA1092573OtherAMERIHEALTH MERCY HEALTH
PA0887614Medicaid
PA000000118667OtherUNISON HEALTH PLAN
PA000198331OtherHIGHMARK BLUE SHIELD
PA0032101000OtherAMERIHEALTH 65
PA0032101000OtherAMERIHEALTH 65
PAP002614OtherGATEWAY HEALTH PLAN