Provider Demographics
NPI:1043205370
Name:TESTA, MARK A (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TESTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1332 W RITNER ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-3537
Mailing Address - Country:US
Mailing Address - Phone:215-309-3222
Mailing Address - Fax:267-930-3686
Practice Address - Street 1:2601 S 12TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4303
Practice Address - Country:US
Practice Address - Phone:215-389-6461
Practice Address - Fax:215-389-3726
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB06014000207Q00000X
PA0S007357C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012858720001Medicaid
027905Medicare ID - Type Unspecified
PA0012858720001Medicaid