Provider Demographics
NPI:1679542799
Name:KOTAPKA, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:KOTAPKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:101 E OLNEY AVE
Mailing Address - Street 2:400
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2421
Mailing Address - Country:US
Mailing Address - Phone:215-456-7000
Mailing Address - Fax:215-254-2599
Practice Address - Street 1:5401 OLD YORK ROAD
Practice Address - Street 2:KLEIN BLDG, STE 501
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-456-6127
Practice Address - Fax:215-457-7602
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-12-07
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Provider Licenses
StateLicense IDTaxonomies
PAPA MD040762E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001288060Medicaid
0000179297Medicare ID - Type Unspecified
PA001288060Medicaid