Provider Demographics
NPI:1538149067
Name:IGOE, MARK J (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:IGOE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:SAINT MARY'S MEDICAL CENTER
Mailing Address - Street 2:LANGHORNE-NEWTOWN ROAD
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047
Mailing Address - Country:US
Mailing Address - Phone:215-710-2161
Mailing Address - Fax:
Practice Address - Street 1:SAINT MARY'S MEDICAL CENTER
Practice Address - Street 2:LANGHORNE-NEWTOWN ROAD
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047
Practice Address - Country:US
Practice Address - Phone:215-710-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS010578L207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH82194Medicare UPIN
PA069150MU1Medicare PIN