Active NPI
Marlon Pemberton
- Medical Technologist
- Normal, IL
National Provider Identifier
1942746185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Technologist
- License
- 246ZE0600X
- Practice address
- 1604 Visa Dr Ste 1
Normal, IL 61761-2195 - Phone
- (309) 454-1100
- Fax
- (309) 454-1107
- NPI assigned
- Jan 11, 2017
- Last updated
- Jan 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | 246ZE0600X | NY | Primary |
Addresses
Primary practice location
1604 Visa Dr Ste 1
Normal, IL 61761-2195
Mailing address
1604 Visa Dr Ste 1
Normal, IL 61761-2195
Phone (309) 454-1100
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 246ZE0600X | NY | MD | Medical Technologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484092800000",
"number": "1942746185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1604 VISA DR STE 1",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612195",
"telephone_number": "309-454-1100",
"fax_number": "309-454-1107"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1604 VISA DR STE 1",
"city": "NORMAL",
"state": "IL",
"postal_code": "617612195",
"telephone_number": "309-454-1100",
"fax_number": "309-454-1107"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEMBERTON",
"first_name": "MARLON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-11",
"last_updated": "2017-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "246QM0706X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Pathology, Medical Technologist",
"state": "NY",
"license": "246ZE0600X",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Normal, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.