Provider Demographics
NPI:1215935655
Name:OSWALD, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:OSWALD
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 W OREGON AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19148-4748
Mailing Address - Country:US
Mailing Address - Phone:267-338-3411
Mailing Address - Fax:267-780-7332
Practice Address - Street 1:330 W OREGON AVE STE 170
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19148-4748
Practice Address - Country:US
Practice Address - Phone:267-338-3411
Practice Address - Fax:267-780-7332
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037652207Q00000X
NJ25MA07862200207Q00000X
PAMD429813207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0117072Medicaid