MEDICARE: DR. MARK BERTRAM SOSTEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	MD065050L	PA

General Provider Information

NPI Number	:	1902881329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK BERTRAM SOSTEK M.D.

Provider Business Mailing Address
First Line	:	1650 FOREST CREEK DR
Second Line	:
City	:	BLUE BELL
State	:	PA
Zip	:	19422-3652
Country	:	US
Telephone Number	:	610-313-9740
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 KING OF PRUSSIA RD
Second Line	:	PENN MEDICINE AT RADNOR
City	:	RADNOR
State	:	PA
Zip	:	19087-5220
Country	:	US
Telephone Number	:	610-902-1544
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	07/08/2007

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