Provider Demographics
NPI:1376659722
Name:MAGASIC, MARIO V (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:V
Last Name:MAGASIC
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:406 LIPPINCOTT DRIVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4128
Mailing Address - Country:US
Mailing Address - Phone:856-983-1900
Mailing Address - Fax:856-983-1914
Practice Address - Street 1:406 LIPPINCOTT DRIVE
Practice Address - Street 2:SUITE E
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4128
Practice Address - Country:US
Practice Address - Phone:856-983-1900
Practice Address - Fax:856-983-1914
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05682000207RG0100X
NJ25MA5682000207RG0100X
NJMA707587207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6458009Medicaid
NJ100009294OtherRAILROAD MEDICARE
NJF15138Medicare UPIN
NJ6458009Medicaid
NJ707587ABUMedicare PIN
F15138Medicare UPIN
NJ707587BL3Medicare PIN