Provider Demographics
NPI:1407852379
Name:LOPATIN, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:LOPATIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 MARYLAND RD
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1709
Mailing Address - Country:US
Mailing Address - Phone:215-657-6776
Mailing Address - Fax:267-913-5962
Practice Address - Street 1:2360 MARYLAND RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090
Practice Address - Country:US
Practice Address - Phone:215-657-6776
Practice Address - Fax:267-913-5961
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD032614E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0054052000OtherKEYSTONE
PA660001149OtherUNITED HEALTH CARE
PA1068970002OtherCIGNA
PA98762OtherAETNA
PAB34999Medicare UPIN