Provider Demographics
NPI:1215967682
Name:LIBASSI, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:LIBASSI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:41 UNIVERSITY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-1873
Mailing Address - Country:US
Mailing Address - Phone:215-710-5522
Mailing Address - Fax:215-710-5181
Practice Address - Street 1:1203 LANGHORNE NEWTOWN RD STE 225
Practice Address - Street 2:
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1237
Practice Address - Country:US
Practice Address - Phone:215-710-6613
Practice Address - Fax:215-710-6614
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2021-05-20
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Provider Licenses
StateLicense IDTaxonomies
PAMD042679E2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014618900004Medicaid
PA0014618900005Medicaid
PA0224098OtherCIGNA
PA0014618900008Medicaid
PA020046024OtherRAILROAD MEDICARE
PA30017960OtherKEYSTONE MERCY
PA3634221OtherAETNA HMO
PA431350OtherPERSONAL CHOICE
PA0014618900009Medicaid
PA0100031000OtherKEYSTONE IBC
PA34799OtherHEALTH PARTNERS
PAPA0026087OtherTRICARE
PA01461890-03OtherAMERICHOICE
PA431350OtherHIGHMARK BLUE SHIELD
PA0224098OtherCIGNA