MEDICARE: DR. MARIO ZICHELLA JR. D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080N0001X	Neonatal-Perinatal Medicine Physician	GBTQ6ZXW	PA
2	390200000X	Student in an Organized Health Care Education/Training Program		NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GBTQ6ZXW	OTHER	PA	PA TRAINING LICENSE NUMBER

General Provider Information

NPI Number	:	1568656981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO ZICHELLA JR. D.O.

Provider Business Mailing Address
First Line	:	9 N 9TH ST
Second Line	:	718
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3121
Country	:	US
Telephone Number	:	973-879-0509
Fax Number	:

Provider Business Practice Location Address
First Line	:	1025 WALNUT STREET
Second Line	:	SUITE 700
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3121
Country	:	US
Telephone Number	:	973-879-0509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	03/09/2012

Similar Medicare Providers

1558705780 — DOUGLAS ALAN JEW
Practice Location Address:

9 N 9TH ST , APT. #305
PHILADELPHIA, PA
19107-3121

Practice Phone: 512-767-4340
Practice Fax:

1699962506 — CASA DOMINICANA, INC
Practice Location Address:

1921 E ALLEGHENY AVE
PHILADELPHIA, PA
19134-3121

Practice Phone: 267-997-5339
Practice Fax:

1053657858 — GAIL CUMMINGS LEVAN L.C.S.W.
Practice Location Address:

2318 GREEN ST
PHILADELPHIA, PA
19130-3121

Practice Phone: 215-260-4881
Practice Fax:

1073912218 — QINGYING WANG
Practice Location Address:

949 TREE ST
PHILADELPHIA, PA
19148-3121

Practice Phone: 267-346-0407
Practice Fax:

1316316854 — HAIRS 2 U WIG BANK
Practice Location Address:

764 S 4TH ST
PHILADELPHIA, PA
19147-3121

Practice Phone: 215-922-2119
Practice Fax:

1578132767 — WYNGATE PRIMARY ARE LLC
Practice Location Address:

110 BLACK HORSE ALY
PHILADELPHIA, PA
19106-3121

Practice Phone: 267-367-2818
Practice Fax:

Directions to “ DR. MARIO ZICHELLA JR. D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.