Provider Demographics
NPI:1760417455
Name:GOEDECKER, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:GOEDECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:717-851-3535
Practice Address - Street 1:2003 SPRINGWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4836
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:717-260-3330
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422476207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1544358OtherHIGHMARK BLUE SHIELD
PA50021846OtherCAPITAL BLUE CROSS-YH
MD621643OtherCAREFIRST MD BCBS
PAP004655OtherGATEWAY-YH
PA100449OtherGEISINGER
PA7288130OtherAETNA
PAP00329337OtherRAILROAD MEDICARE
PA146446OtherUNISON-YH PCP
PA20027894OtherAMERIHEALTH MERCY-YH
PA106215OtherJOHNS HOPKINS
PA100815126Medicaid
PA2117318OtherMAMSI-YH
PA150700OtherUNISON-YH OB
MD621643OtherCAREFIRST MD BCBS
PA146446OtherUNISON-YH PCP