Provider Demographics
NPI:1306806492
Name:MISHKIN, MARK H (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:MISHKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3050 HAMILTON BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3691
Mailing Address - Country:US
Mailing Address - Phone:484-223-3300
Mailing Address - Fax:484-223-3464
Practice Address - Street 1:3050 HAMILTON BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3691
Practice Address - Country:US
Practice Address - Phone:484-223-3300
Practice Address - Fax:484-223-3464
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-09-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023235E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA117897Medicare ID - Type UnspecifiedMEDICARE
PAD71189Medicare UPIN