Provider Demographics
NPI:1003863937
Name:KAHN, MARK BENNET (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENNET
Last Name:KAHN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6601 SPRINGBANK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-3712
Mailing Address - Country:US
Mailing Address - Phone:215-849-0667
Mailing Address - Fax:
Practice Address - Street 1:8200 FLOURTOWN AVE
Practice Address - Street 2:STE 2
Practice Address - City:WYNDMOOR
Practice Address - State:PA
Practice Address - Zip Code:19038-7976
Practice Address - Country:US
Practice Address - Phone:215-836-5120
Practice Address - Fax:215-248-8989
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2011-12-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD-032411-E2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC68490Medicare UPIN