Provider Demographics
NPI:1952600504
Name:MARK A. OLIVER, M.D.,P.A.
Entity type:Organization
Organization Name:MARK A. OLIVER, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-538-0165
Mailing Address - Street 1:182 SOUTH ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-5377
Mailing Address - Country:US
Mailing Address - Phone:973-538-0165
Mailing Address - Fax:973-538-9344
Practice Address - Street 1:182 SOUTH ST
Practice Address - Street 2:SUITE 2
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5377
Practice Address - Country:US
Practice Address - Phone:973-538-0165
Practice Address - Fax:973-538-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-22
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03297900261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC53106Medicare UPIN