Provider Demographics
NPI:1902881329
Name:SOSTEK, MARK BERTRAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BERTRAM
Last Name:SOSTEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Suffix:
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Mailing Address - Street 1:1650 FOREST CREEK DR
Mailing Address - Street 2:
Mailing Address - City:BLUE BELL
Mailing Address - State:PA
Mailing Address - Zip Code:19422-3652
Mailing Address - Country:US
Mailing Address - Phone:610-313-9740
Mailing Address - Fax:
Practice Address - Street 1:250 KING OF PRUSSIA RD
Practice Address - Street 2:PENN MEDICINE AT RADNOR
Practice Address - City:RADNOR
Practice Address - State:PA
Practice Address - Zip Code:19087-5220
Practice Address - Country:US
Practice Address - Phone:610-902-1544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065050L207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
011284JDOMedicare ID - Type Unspecified
E14752Medicare UPIN