Provider Demographics
NPI:1356316707
Name:MASCARI, MARK LOUIS (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:MASCARI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8012 BRETZ DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-9748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:717-231-8656
Practice Address - Street 1:8012 BRETZ DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-9748
Practice Address - Country:US
Practice Address - Phone:717-988-9340
Practice Address - Fax:717-231-8656
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006571L207Q00000X, 207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02277200OtherBLUE CROSS
PA682304OtherMEDICARE #
PA001167064Medicaid