Healthcare Provider Details

I. General information

NPI: 1407852379
Provider Name (Legal Business Name): MARK A LOPATIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 11/27/2023
Certification Date: 03/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 MARYLAND RD
WILLOW GROVE PA
19090
US

IV. Provider business mailing address

2360 MARYLAND RD
WILLOW GROVE PA
19090-1709
US

V. Phone/Fax

Practice location:
  • Phone: 215-657-6776
  • Fax: 267-913-5961
Mailing address:
  • Phone: 215-657-6776
  • Fax: 267-913-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD032614E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: