Provider Demographics
NPI:1700913456
Name:LODICO, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:LODICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 STONEWOOD DR
Mailing Address - Street 2:STE. 151
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090
Mailing Address - Country:US
Mailing Address - Phone:724-933-0300
Mailing Address - Fax:724-933-0456
Practice Address - Street 1:7000 STONEWOOD DR
Practice Address - Street 2:SUITE 151
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-7376
Practice Address - Country:US
Practice Address - Phone:724-933-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD047135L207LP2900X, 174400000X
WV27284207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012859990001Medicaid
PA722725Medicare PIN
PAF27569Medicare UPIN