Provider Demographics
NPI:1902849847
Name:KHARKOVER, MARK Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:Y
Last Name:KHARKOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:402 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:1608 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076-1600
Practice Address - Country:US
Practice Address - Phone:908-322-6000
Practice Address - Fax:908-322-7770
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA07102900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8714606Medicaid
H55391Medicare UPIN
055142SK3Medicare PIN
NJ8714606Medicaid