Active NPI
Philip M Marden MD SC
- Pediatrics Physician
- Watertown, WI
National Provider Identifier
1073652525
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 14664
- Legal business name
- PHILIP M MARDEN MD SC
- Practice address
- 123 Hospital Drive
Suite 212
Watertown, WI 53098-3336 - Phone
- (920) 261-3898
- Fax
- (262) 567-0368
- NPI assigned
- Feb 5, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Philip M Marden, MD
- Title
- President
- Phone
- (262) 567-0366
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Allergy Physician | 207KA0200X | 14664 | WI | |
| Family Medicine Physician | 207Q00000X | 14664 | WI | |
| Pediatrics Physician | 208000000X | 14664 | WI | Primary |
Addresses
Primary practice location
123 Hospital Drive
Suite 212
Watertown, WI 53098-3336
Mailing address
123 Hospital Drive
Suite 212
Watertown, WI 53098-3336
Phone (920) 261-3898
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 14664 | Other | WI | ST OF WIS MEDICAL LICENSE |
| 4308968 | Other | AETNA | |
| 31212300 | Medicaid | WI | |
| 718112 | Other | MANAGED HEALTH SERVICES | |
| 1200110 | Other | UNITED HEALTHCARE | |
| 12659 | Other | DEAN HEALTH PLAN | |
| 112760524654 | Other | HUMANA | |
| MARDENPHI | Other | MERCYCARE HEALTH PLANS | |
| W003437 | Other | CHAMPUS | |
| AS68366510001 | Other | CIGNA | |
| 1000283 | Other | PHYSICIANS PLUS INSURANCE | |
| 213688 | Other | ONE HEALTH PLAN | |
| 52D0388538 | Other | CLIA CERTIFICATE |
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1354752000000",
"number": "1073652525",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "123 HOSPITAL DRIVE",
"address_2": "SUITE 212",
"city": "WATERTOWN",
"state": "WI",
"postal_code": "530983336",
"telephone_number": "920-261-3898",
"fax_number": "262-567-0368"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 HOSPITAL DRIVE",
"address_2": "SUITE 212",
"city": "WATERTOWN",
"state": "WI",
"postal_code": "530983336",
"telephone_number": "920-261-3898",
"fax_number": "262-567-0368"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PHILIP M MARDEN MD SC",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-05",
"last_updated": "2012-12-06",
"status": "A",
"authorized_official_last_name": "MARDEN",
"authorized_official_first_name": "PHILIP",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "262-567-0366",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207KA0200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Allergy & Immunology, Allergy",
"state": "WI",
"license": "14664",
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Family Medicine",
"state": "WI",
"license": "14664",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Pediatrics",
"state": "WI",
"license": "14664",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ST OF WIS MEDICAL LICENSE",
"identifier": "14664",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4308968",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "31212300",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH SERVICES",
"identifier": "718112",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "1200110",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEAN HEALTH PLAN",
"identifier": "12659",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "112760524654",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE HEALTH PLANS",
"identifier": "MARDENPHI",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "W003437",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "AS68366510001",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PHYSICIANS PLUS INSURANCE",
"identifier": "1000283",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ONE HEALTH PLAN",
"identifier": "213688",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CLIA CERTIFICATE",
"identifier": "52D0388538",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Watertown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.