Provider Demographics
NPI:1831421627
Name:MARK J COSSENTINO MD PA
Entity type:Organization
Organization Name:MARK J COSSENTINO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:COSSENTINO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:915-328-4793
Mailing Address - Street 1:1700 CURIE DR
Mailing Address - Street 2:4800
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-2905
Mailing Address - Country:US
Mailing Address - Phone:915-328-4793
Mailing Address - Fax:915-591-9215
Practice Address - Street 1:1700 CURIE DR
Practice Address - Street 2:4800
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-2905
Practice Address - Country:US
Practice Address - Phone:915-328-4793
Practice Address - Fax:915-591-9215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM9935207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM9935OtherTEXAS MEDICAL LICENSE