Provider Demographics
NPI:1134127178
Name:DELAURENTIS, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DELAURENTIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOCIATES PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-751-0123
Mailing Address - Fax:856-751-0535
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2023-12-14
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA048476002085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3097883OtherAETNA
509023OtherAMERIHEALTH PPO
1168017OtherHORIZON NJ HEALTH
509023OtherHIGHMARK PA BLUE SHIELD
0109898000OtherAMERIHEALTH HMO
10434061OtherCAQH
300133897OtherRAILROAD MEDICARE
A3738029OtherOXFORD HEALTH
NJ7940602Medicaid
3097883OtherAETNA
A3738029OtherOXFORD HEALTH