Provider Demographics
NPI:1558347625
Name:FRISCH, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FRISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:623 UNRUH AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19111
Mailing Address - Country:US
Mailing Address - Phone:215-214-1094
Mailing Address - Fax:215-214-1098
Practice Address - Street 1:7604 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19111
Practice Address - Country:US
Practice Address - Phone:215-745-8989
Practice Address - Fax:215-745-9072
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD030592E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010655470005Medicaid
PA090569JTQMedicare ID - Type Unspecified
C29537Medicare UPIN