Provider Demographics
NPI:1710022975
Name:ABAD, MARIO D JR (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:D
Last Name:ABAD
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-4903
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:51 BUSINESS CAMPUS WAY STE 200
Practice Address - Street 2:
Practice Address - City:DUNCANNON
Practice Address - State:PA
Practice Address - Zip Code:17020-9596
Practice Address - Country:US
Practice Address - Phone:717-834-3108
Practice Address - Fax:717-834-6911
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2018-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05298400207R00000X
PAMD050295L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G43726Medicare UPIN