Healthcare Provider Details

I. General information

NPI: 1346290392
Provider Name (Legal Business Name): MARK A RUPERT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 S BRYN MAWR AVE
BRYN MAWR PA
19010-3121
US

IV. Provider business mailing address

130 S. BRYN MAWR AVE. BRYN MAWR HOSPITAL
BRYN MAWR PA
19010
US

V. Phone/Fax

Practice location:
  • Phone: 717-719-2973
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA-003224-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: