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Individual

MARK PREZIOSO

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT

Contact information

Practice address
250 S 21ST ST, EASTON, PA 18042-3851
(610) 250-4000
Mailing address
3105 FLORIAN ST, EASTON, PA 18045-5982
(724) 255-0820

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
OA002530
PA
363AM0700X
Medical Physician Assistant
Primary
MA054542
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
MA054542
MEDICAL LICENSE NUMBER
PA
01
OA002530
OSTEOPATHIC LICENSE NUMBER
PA
Enumeration date
12/15/2010
Last updated
12/15/2010
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