Provider Demographics
NPI:1447252333
Name:GARDEN, MARC DAVIS (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:DAVIS
Last Name:GARDEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1703 S BROAD ST
Mailing Address - Street 2:PHILADELPHIA EYE ASSOCIATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-1536
Mailing Address - Country:US
Mailing Address - Phone:215-339-8100
Mailing Address - Fax:215-339-8103
Practice Address - Street 1:1703 S BROAD ST
Practice Address - Street 2:PHILADELPHIA EYE ASSOCIATES
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-1536
Practice Address - Country:US
Practice Address - Phone:215-339-8100
Practice Address - Fax:215-339-8103
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD02690SE207W00000X
NJ25MA05338400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA099578Medicaid
PA099578Medicaid
105490EUTMedicare ID - Type Unspecified