Provider Demographics
NPI:1942407374
Name:FUSSA, MARK JAMES (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:FUSSA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 HADDONFIELD BERLIN RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:709 HADDONFIELD BERLIN RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3715
Practice Address - Country:US
Practice Address - Phone:856-566-3190
Practice Address - Fax:856-783-2193
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08120000207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0163520Medicaid
NJP00728548OtherRAILROAD MEDICARE
NJ0163520Medicaid
NJP00728548OtherRAILROAD MEDICARE