Provider Demographics
NPI:1528336476
Name:MIRCETIC, MARKO (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:MARKO
Middle Name:
Last Name:MIRCETIC
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 MARKET ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3317
Mailing Address - Country:US
Mailing Address - Phone:215-746-4111
Mailing Address - Fax:215-573-5668
Practice Address - Street 1:3535 MARKET ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3317
Practice Address - Country:US
Practice Address - Phone:215-746-4111
Practice Address - Fax:215-573-5662
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4614472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty