Individual
DR. MARK J MENTRIKOSKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 N ACADEMY AVE, DANVILLE, PA 17822-1678
(570) 271-6338
(570) 271-6105
Mailing address
100 N ACADEMY AVE, DANVILLE, PA 17822-4903
(570) 271-6144
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
MD459836
PA
207ZP0101X
Anatomic Pathology Physician
Q5040
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
MD459836
PA
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Q5040
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
347336501
—
TX
Enumeration date
03/25/2010
Last updated
10/20/2023
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