Provider Demographics
NPI:1851390199
Name:MORRIS, MARK MACCOLLOM (DO, FACOP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MACCOLLOM
Last Name:MORRIS
Suffix:
Gender:M
Credentials:DO, FACOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 MILLBURN AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1071
Mailing Address - Country:US
Mailing Address - Phone:973-258-1776
Mailing Address - Fax:
Practice Address - Street 1:26 MILLBURN AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1071
Practice Address - Country:US
Practice Address - Phone:973-258-1776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB07847900204D00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM