Provider Demographics
NPI:1184890436
Name:FAMADOR, MARK BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:BENJAMIN
Last Name:FAMADOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5000 SAGEMORE DR STE 205
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4332
Mailing Address - Country:US
Mailing Address - Phone:856-983-3866
Mailing Address - Fax:856-985-8148
Practice Address - Street 1:5000 SAGEMORE DR STE 205
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-4332
Practice Address - Country:US
Practice Address - Phone:856-983-3866
Practice Address - Fax:856-985-8148
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4381852084P0800X, 2084P0800X
NJ25MA083972002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA164293Medicare UPIN