Provider Demographics
NPI:1043272818
Name:MARPLE MEDICAL ASSOCIATES
Entity type:Organization
Organization Name:MARPLE MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLADSTONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-353-6400
Mailing Address - Street 1:1999 SPROUL RD
Mailing Address - Street 2:STE21
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3508
Mailing Address - Country:US
Mailing Address - Phone:610-353-6400
Mailing Address - Fax:610-353-3420
Practice Address - Street 1:1999 SPROUL RD
Practice Address - Street 2:STE21
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3508
Practice Address - Country:US
Practice Address - Phone:610-353-6400
Practice Address - Fax:610-353-3420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA58229OtherAETNA
PA0007335830003Medicaid
PA131926OtherBLUE SHIELD
PA0031381000OtherKEYSTONE
PA131926Medicare PIN