Provider Demographics
NPI:1538241625
Name:KARK, JOHN ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALEXANDER
Last Name:KARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:615 CHESTNUT ST
Mailing Address - Street 2:14TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19106-4404
Mailing Address - Country:US
Mailing Address - Phone:215-955-9628
Mailing Address - Fax:215-955-2420
Practice Address - Street 1:1015 CHESTNUT STREET
Practice Address - Street 2:SUITE 1020
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4310
Practice Address - Country:US
Practice Address - Phone:215-955-4730
Practice Address - Fax:215-503-9188
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0016436207RH0003X
PAMD431818207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0153711Medicaid
DC0485740Medicaid
MD6019200Medicaid
DC0485740Medicaid
MD6019200Medicaid
PA121965Medicare PIN