Provider Demographics
NPI:1770803330
Name:DECARO, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:DECARO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:833 CHESTNUT STREET
Mailing Address - Street 2:SUITE 701
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4409
Mailing Address - Country:US
Mailing Address - Phone:215-955-6180
Mailing Address - Fax:215-955-6410
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:215-955-5050
Practice Address - Fax:215-955-7499
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2018-12-20
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Provider Licenses
StateLicense IDTaxonomies
PAMD449736207R00000X, 207RC0000X
PAMT197358207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine