Provider Demographics
NPI:1255389326
Name:SAXON, MARK J (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:SAXON
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:480 PIERCE STREET
Mailing Address - Street 2:SUITE 212
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-718-1996
Mailing Address - Fax:570-718-1997
Practice Address - Street 1:480 PIERCE STREET
Practice Address - Street 2:SUITE 212
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-718-1996
Practice Address - Fax:570-718-1997
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA0S-008157L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000266238OtherUNISON
PA0015924070002Medicaid
PA0015924070002Medicaid
PA875009Medicare PIN
000000266238OtherUNISON