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General NPI Number Information
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NPI Number | 1164434874
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Entity Type | Individual
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Provider Name | MARK A. MONACO D.O.
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Gender | Male
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 05/27/2009
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Provider Practice Location Address
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Address Line | 2000 SPROUL RD SUITE 100 MARPLE COMMONS
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City | BROOMALL
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State | PA
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Zip | 19008-2424
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Country | US
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Telephone | 610-353-3500
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Fax | 610-353-2015
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Provider Business Mailing Address
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Address Line | 2000 SPROUL RD SUITE 100 MARPLE COMMONS
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City | BROOMALL
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State | PA
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Zip | 19008-2424
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Country | US
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Telephone | 610-353-3500
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Fax | 610-353-2015
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS-007200-L
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License Number State | PA
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