Individual
MARK BOUDEWIJNS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
(215) 590-2730
Mailing address
3401 CIVIC CENTER BLVD, PHILADELPHIA, PA 19104-4319
Taxonomy
Speciality
Code
Description
License number
State
2086S0120X
Pediatric Surgery Physician
Primary
LT000966
PA
Other
Enumeration date
06/30/2023
Last updated
06/30/2023
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