Provider Demographics
NPI:1447257498
Name:TROCHIMOWICZ, MARK STEPHEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:TROCHIMOWICZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:400 SOUTH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-5057
Mailing Address - Country:US
Mailing Address - Phone:302-325-2309
Mailing Address - Fax:302-325-6365
Practice Address - Street 1:400 SOUTH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-5057
Practice Address - Country:US
Practice Address - Phone:302-325-2309
Practice Address - Fax:302-325-6365
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07769900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07769900OtherNJ MEDICAL LICENSE NUMBER
P00470699OtherRAILROAD MEDICARE PTAN
NJ084104S9TMedicare ID - Type Unspecified
NJI18310Medicare UPIN