Provider Demographics
NPI:1164434874
Name:MONACO, MARK A (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MONACO
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:2000 SPROUL RD SUITE 100
Mailing Address - Street 2:MARPLE COMMONS
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-2424
Mailing Address - Country:US
Mailing Address - Phone:610-353-3500
Mailing Address - Fax:610-353-2015
Practice Address - Street 1:2000 SPROUL RD SUITE 100
Practice Address - Street 2:MARPLE COMMONS
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-2424
Practice Address - Country:US
Practice Address - Phone:610-353-3500
Practice Address - Fax:610-353-2015
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2009-05-27
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Provider Licenses
StateLicense IDTaxonomies
PAOS-007200-L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA079135OtherPA BLUE SHIELD
PA112678OtherCOVENTRY
PAOS-007200-LOtherSTATE LICENSE NUMBER
PA0222047000OtherKEYSTONE
PA30025953OtherKEYSTONE MERCY
PA0014669940006Medicaid
PA010056677OtherMEDICARE RR
PA0222047000OtherIBC PRODUCTS
PA118066OtherAETNA
PAP663879OtherOXFORD
PA0222047000OtherIBC PRODUCTS
PA079135FWWMedicare PIN