Provider Demographics
NPI:1689605123
Name:PATERSON, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PATERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HYGEIA DR
Mailing Address - Street 2:SUITE 2300 / FINANCE DEPARTMENT
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2049
Mailing Address - Country:US
Mailing Address - Phone:302-623-7228
Mailing Address - Fax:302-623-7425
Practice Address - Street 1:300 BIDDLE AVE
Practice Address - Street 2:CONNOR BUILDING - GLASGOW SPRINGSIDE PLAZA
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-3969
Practice Address - Country:US
Practice Address - Phone:302-838-4700
Practice Address - Fax:302-838-4710
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10001564225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist