Provider Demographics
NPI:1619410842
Name:DEMITRACK, MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:DEMITRACK
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:3222 PHOENIXVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-9615
Mailing Address - Country:US
Mailing Address - Phone:610-640-4202
Mailing Address - Fax:610-640-4206
Practice Address - Street 1:3222 PHOENIXVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-9615
Practice Address - Country:US
Practice Address - Phone:610-640-4202
Practice Address - Fax:610-640-4206
Is Sole Proprietor?:No
Enumeration Date:2016-11-20
Last Update Date:2016-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD42222482084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry