Individual
DR. MARK ROBERT IANTOSCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 UNIVERSITY DR, HERSHEY, PA 17033-2360
(800) 243-1455
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
036210
CT
207T00000X
Neurological Surgery Physician
Primary
MD429820
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001362102
—
CT
05
—
1017101470001
—
PA
Enumeration date
05/12/2006
Last updated
11/16/2018
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