Provider Demographics
NPI:1346598463
Name:DEMBERT, MARK LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LAWRENCE
Last Name:DEMBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7318 BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1634
Mailing Address - Country:US
Mailing Address - Phone:610-357-2408
Mailing Address - Fax:215-248-6206
Practice Address - Street 1:7318 BRYAN ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1634
Practice Address - Country:US
Practice Address - Phone:610-357-2408
Practice Address - Fax:215-248-6206
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD018052E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry