Healthcare Provider Details

I. General information

NPI: 1487005625
Provider Name (Legal Business Name): MARK JOSEPH DELEO PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1112
US

IV. Provider business mailing address

760 SCRANTON CARBONDALE HWY
SCRANTON PA
18508-1112
US

V. Phone/Fax

Practice location:
  • Phone: 570-532-9456
  • Fax: 570-243-9361
Mailing address:
  • Phone: 570-532-9456
  • Fax: 570-243-9361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA8375
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: