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General NPI Number Information
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NPI Number | 1083905947
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Entity Type | Individual
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Provider Name | MARK PETER JAWORSKI M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/27/2011
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Last Update Date | 04/27/2011
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Provider Practice Location Address
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Address Line | 4110 APALOGEN RD
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City | PHILADELPHIA
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State | PA
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Zip | 19129-5504
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Country | US
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Telephone | 215-848-1595
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 63624
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City | PHILADELPHIA
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State | PA
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Zip | 19147-7424
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Country | US
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Telephone | 856-904-0098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | MT190815
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License Number State | PA
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