Provider Demographics
NPI:1073602546
Name:PELLO, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:PELLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3 COOPER PLZ
Mailing Address - Street 2:502
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1438
Mailing Address - Country:US
Mailing Address - Phone:856-968-7433
Mailing Address - Fax:856-968-8499
Practice Address - Street 1:3 COOPER PLZ RM 411
Practice Address - Street 2:COOPER SURGICAL ASSOCIATES
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1438
Practice Address - Country:US
Practice Address - Phone:856-342-3412
Practice Address - Fax:856-365-1180
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-06-18
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Provider Licenses
StateLicense IDTaxonomies
NJMA32132208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1010875OtherHORIZON NJ HEALTH
NJCA0000068OtherAMERICHOICE
NJ16735OtherAETNA
NJ6710804OtherCIGNA
NJP531590OtherOXFORD HEALTH PLAN
NJ3K6211OtherHEALTHNET
NJ400785OtherAMERIHEALTH PPO/PA BS
NJ1328701Medicaid
NJ0097397000OtherAMERIHEALTH/KESYTONE/IBC
NJ1242926OtherUNITED HEALTHCARE
NJ22502OtherUNIVERSITY HEALTH PLAN
NJ6710804OtherCIGNA
NJ400785 AN0Medicare PIN