Provider Demographics
NPI:1891907143
Name:FINNEGAN, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:FINNEGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22581
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-2581
Mailing Address - Country:US
Mailing Address - Phone:610-482-4795
Mailing Address - Fax:856-528-3117
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 158E
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-2126
Practice Address - Fax:610-642-7814
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042632E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE95593Medicare UPIN