Provider Demographics
NPI:1073583902
Name:DIPILLO, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DIPILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 WESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1130
Mailing Address - Country:US
Mailing Address - Phone:610-376-1981
Mailing Address - Fax:610-376-3153
Practice Address - Street 1:2630 WESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1130
Practice Address - Country:US
Practice Address - Phone:610-376-1981
Practice Address - Fax:610-376-3153
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD044541E207W00000X, 207WX0009X
MA288686207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1415500Medicaid
PA180026325OtherRAILROAD MEDICARE
PA1415500Medicaid
PA180026325OtherRAILROAD MEDICARE
PA565225H6RMedicare PIN