Provider Demographics
NPI:1407829070
Name:DECKER, MARK JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEFFREY
Last Name:DECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SLOAN RD.
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-4304
Mailing Address - Country:US
Mailing Address - Phone:610-793-1580
Mailing Address - Fax:484-451-1101
Practice Address - Street 1:4 SLOAN RD.
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-4304
Practice Address - Country:US
Practice Address - Phone:860-871-0220
Practice Address - Fax:860-875-3993
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127284207Q00000X
PAMD433213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT00121543301Medicaid
CT00121543301Medicaid