Provider Demographics
NPI:1497758908
Name:MARSILI, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:MARSILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:327 N WASHINGTON AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18503-1535
Mailing Address - Country:US
Mailing Address - Phone:570-961-5522
Mailing Address - Fax:570-207-5579
Practice Address - Street 1:327 N WASHINGTON AVE
Practice Address - Street 2:STE 200
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18503-1535
Practice Address - Country:US
Practice Address - Phone:570-961-5522
Practice Address - Fax:570-207-5579
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD044620L207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1398366Medicaid
PAF15338Medicare UPIN
PA708782Medicare ID - Type Unspecified