Active NPI
Marvin V. Gozum, M.D.
- Internal Medicine Physician
- Philadelphia, PA
National Provider Identifier
1467486381
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MD-038691-E
- Practice address
- 833 Chestnut St
Suite 701
Philadelphia, PA 19107-4414 - Phone
- (215) 955-6180
- Fax
- (215) 955-6410
- NPI assigned
- Jul 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MD-038691-E | PA | Primary |
Addresses
Primary practice location
833 Chestnut St
Suite 701
Philadelphia, PA 19107-4414
Mailing address
833 Chestnut St
Suite 701
Philadelphia, PA 19107-4414
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7710305 | Medicaid | NJ | |
| 001141970 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD-038691-E | PA | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410307200000",
"number": "1467486381",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "833 CHESTNUT ST",
"address_2": "SUITE 701",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191074414"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "833 CHESTNUT ST",
"address_2": "SUITE 701",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191074414",
"telephone_number": "215-955-6180",
"fax_number": "215-955-6410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOZUM",
"first_name": "MARVIN",
"middle_name": "V.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-10",
"last_updated": "2014-09-10",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "PA",
"license": "MD-038691-E",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7710305",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001141970",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.