Provider Demographics
NPI:1336918994
Name:TYLER, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TYLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6600 TIMRA CIR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1925
Mailing Address - Country:US
Mailing Address - Phone:215-479-6066
Mailing Address - Fax:
Practice Address - Street 1:6600 TIMRA CIR
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1925
Practice Address - Country:US
Practice Address - Phone:215-479-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-25
Last Update Date:2023-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA75803601251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health