Provider Demographics
NPI:1376310276
Name:SAFFICI, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SAFFICI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 S RIDING BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2733
Mailing Address - Country:US
Mailing Address - Phone:302-312-7104
Mailing Address - Fax:
Practice Address - Street 1:125 S RIDING BLVD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2733
Practice Address - Country:US
Practice Address - Phone:302-312-7104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program