Basic Information
Provider Information
NPI: 1669453544
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MARKUS
FirstName: HELENE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1517 THORNBERRY RD
Address2:  
City: WYNCOTE
State: PA
PostalCode: 190952310
CountryCode: US
TelephoneNumber: 2158874536
FaxNumber:  
Practice Location
Address1: 1107 E BALTIMORE PIKE
Address2:  
City: KENNETT SQUARE
State: PA
PostalCode: 193482366
CountryCode: US
TelephoneNumber: 6103885500
FaxNumber: 4842590200
Other Information
ProviderEnumerationDate: 11/08/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000XDS024700LPAY Dental ProvidersDentist 

No ID Information.


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