Provider Demographics
NPI:1770327702
Name:MARK COCKBURN MD PA
Entity type:Organization
Organization Name:MARK COCKBURN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:COCKBURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-310-0926
Mailing Address - Street 1:12990 SW 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2730
Mailing Address - Country:US
Mailing Address - Phone:914-310-0926
Mailing Address - Fax:
Practice Address - Street 1:8201 N UNIVERSITY DR STE 204
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1709
Practice Address - Country:US
Practice Address - Phone:914-310-0926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-24
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma SurgeryGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty