Individual
DR. MARIO ZICHELLA JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1025 WALNUT STREET, SUITE 700, PHILADELPHIA, PA 19107-3121
(973) 879-0509
Mailing address
9 N 9TH ST, 718, PHILADELPHIA, PA 19107-3121
(973) 879-0509
Taxonomy
Speciality
Code
Description
License number
State
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
GBTQ6ZXW
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GBTQ6ZXW
PA TRAINING LICENSE NUMBER
PA
Enumeration date
08/29/2007
Last updated
03/09/2012
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