Provider Demographics
NPI:1154328110
Name:PYLES, MARK C (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:PYLES
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 1:695 E. 16TH ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:BERWICK
Mailing Address - State:PA
Mailing Address - Zip Code:18603
Mailing Address - Country:US
Mailing Address - Phone:570-759-1833
Mailing Address - Fax:570-759-0314
Practice Address - Street 1:695 E. 16TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:BERWICK
Practice Address - State:PA
Practice Address - Zip Code:18603
Practice Address - Country:US
Practice Address - Phone:570-759-1833
Practice Address - Fax:570-759-0314
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD028609E208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010468370002Medicaid
PA169319Medicare ID - Type Unspecified
B40562Medicare UPIN