Provider Demographics
NPI:1689927774
Name:MARK B. FABI, M.D., P.C.
Entity Type:Organization
Organization Name:MARK B. FABI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISSTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:FRIEDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-261-4053
Mailing Address - Street 1:834 CHESTNUT ST
Mailing Address - Street 2:427
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5127
Mailing Address - Country:US
Mailing Address - Phone:856-261-4053
Mailing Address - Fax:
Practice Address - Street 1:834 CHESTNUT ST
Practice Address - Street 2:427
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5127
Practice Address - Country:US
Practice Address - Phone:856-261-4053
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-26
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA=========OtherMEDICARE B