Provider Demographics
NPI:1912911405
Name:INDZONKA, MARK FRANCIS (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:FRANCIS
Last Name:INDZONKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 INDEPENDENCE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301-7916
Mailing Address - Country:US
Mailing Address - Phone:570-421-3800
Mailing Address - Fax:570-421-8014
Practice Address - Street 1:505 INDEPENDENCE RD
Practice Address - Street 2:SUITE B
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-7916
Practice Address - Country:US
Practice Address - Phone:570-421-3800
Practice Address - Fax:570-421-8014
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043750E207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014131860005Medicaid
741133Medicare ID - Type Unspecified
F54753Medicare UPIN