Provider Demographics
NPI:1699038570
Name:GONZALES, MARK A (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GONZALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:YORK HOSPITAL
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2450
Mailing Address - Fax:717-851-3469
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2450
Practice Address - Fax:717-851-3469
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2016-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS017726207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP01569045Medicare PIN