Healthcare Provider Details

I. General information

NPI: 1023132867
Provider Name (Legal Business Name): HEALTHMARK, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CRESCENT DR. NAVY YARD SUITE 100
PHILADELPHIA PA
19112
US

IV. Provider business mailing address

1CRESCENT DR. NAVY YARD SUITE 100
PHILADELPHIA PA
19112
US

V. Phone/Fax

Practice location:
  • Phone: 215-952-9900
  • Fax: 215-952-9977
Mailing address:
  • Phone: 215-952-9900
  • Fax: 215-952-9977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License NumberMD058825L
License Number StatePA

VIII. Authorized Official

Name: MS. DIANE WILDERMUTH
Title or Position: DIRECTOR
Credential: R.N.
Phone: 215-952-9900