Provider Demographics
NPI:1659563740
Name:SALCONE, MARK ANTHONY (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:SALCONE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:STANTON
Mailing Address - State:TX
Mailing Address - Zip Code:79782-0640
Mailing Address - Country:US
Mailing Address - Phone:432-607-3200
Mailing Address - Fax:432-607-3644
Practice Address - Street 1:600 EAST INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782-0640
Practice Address - Country:US
Practice Address - Phone:432-607-3200
Practice Address - Fax:432-607-3644
Is Sole Proprietor?:No
Enumeration Date:2007-08-13
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS3292208600000X
NJ25MB09012800208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX404319201Medicaid
NJ0280089Medicaid