Provider Demographics
NPI:1083786636
Name:VOLPICELLI, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:VOLPICELLI
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 1:904 SILVER SPUR RD
Mailing Address - Street 2:SUITE 497
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3800
Mailing Address - Country:US
Mailing Address - Phone:650-400-2884
Mailing Address - Fax:424-271-9248
Practice Address - Street 1:3828 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2408
Practice Address - Country:US
Practice Address - Phone:310-504-1622
Practice Address - Fax:424-271-9248
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59030207W00000X, 207Q00000X, 207RB0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
180013421OtherRAILROAD MEDICARE
CA00G590300Medicaid
180013421OtherRAILROAD MEDICARE
E38315Medicare UPIN