Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 002534 L | PA |
N | 111NN0400X | Neurology | 038 004717 | IL |
NPI | 1073515102 |
---|---|
Provider Name | Dr. Mark Anthony Saracino |
First Address | King Of Prussia, PA 19406-1334 |
Second Address | King Of Prussia, PA 19406-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2005 |
Last Update Date | 06/12/2017 |