Provider Demographics
NPI:1841408663
Name:MARK J. CERCIELLO M.D., P.C.
Entity Type:Organization
Organization Name:MARK J. CERCIELLO M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:CERCIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-821-2815
Mailing Address - Street 1:451 W CHEW ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18102-3472
Mailing Address - Country:US
Mailing Address - Phone:610-821-2815
Mailing Address - Fax:610-821-8031
Practice Address - Street 1:451 W CHEW ST
Practice Address - Street 2:SUITE 207
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102-3472
Practice Address - Country:US
Practice Address - Phone:610-821-2815
Practice Address - Fax:610-821-8031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000626313001Medicaid
PA000626313001Medicaid