Provider Demographics
NPI:1366482739
Name:SAKS, MARK A (MD, MHP)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:SAKS
Suffix:
Gender:M
Credentials:MD, MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1601 CHERRY ST
Mailing Address - Street 2:SUITE 11511
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1321
Mailing Address - Country:US
Mailing Address - Phone:215-255-3782
Mailing Address - Fax:215-255-7825
Practice Address - Street 1:230 N BROAD ST
Practice Address - Street 2:DREXELEMERGENCY MED HUH
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-1121
Practice Address - Country:US
Practice Address - Phone:215-762-7963
Practice Address - Fax:215-246-5793
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD424883207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101254304Medicaid
PA090781Medicare ID - Type Unspecified
PA101254304Medicaid