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General NPI Number Information
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NPI Number | 1023132867
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Entity Type | Organization
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Legal Business Name | HEALTHMARK, INCORPORATED
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1 CRESCENT DR. NAVY YARD SUITE 100
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City | PHILADELPHIA
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State | PA
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Zip | 19112
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Country | US
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Telephone | 215-952-9900
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Fax | 215-952-9977
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Provider Business Mailing Address
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Address Line | 1CRESCENT DR. NAVY YARD SUITE 100
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City | PHILADELPHIA
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State | PA
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Zip | 19112
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Country | US
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Telephone | 215-952-9900
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Fax | 215-952-9977
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. DIANE WILDERMUTH
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Credential | R.N.
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Telephone | 215-952-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | MD058825L
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License Number State | PA
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