Organization
HEALTHMARK, INCORPORATED
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANE WILDERMUTH R.N. (DIRECTOR)
(215) 952-9900
Entity
Organization
Contact information
Practice address
1 CRESCENT DR., NAVY YARD SUITE 100, PHILADELPHIA, PA 19112
(215) 952-9900
(215) 952-9977
Mailing address
1CRESCENT DR., NAVY YARD SUITE 100, PHILADELPHIA, PA 19112
(215) 952-9900
(215) 952-9977
Taxonomy
Speciality
Code
Description
License number
State
261QX0100X
Occupational Medicine Clinic/Center
Primary
MD058825L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
72118
PHYSICIAN ASSISTANT
PA
Enumeration date
03/19/2007
Last updated
08/22/2020
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