Basic Information
Provider Information
NPI: 1912550450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FIGGIE
FirstName: MARK
MiddleName: PHILLIPS
NamePrefix: DR.
NameSuffix: JR.
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 PENN RD UNIT 545
Address2:  
City: WYNNEWOOD
State: PA
PostalCode: 190961463
CountryCode: US
TelephoneNumber: 2039216976
FaxNumber:  
Practice Location
Address1: 245 N 15TH ST FL 6
Address2:  
City: PHILADELPHIA
State: PA
PostalCode: 191021101
CountryCode: US
TelephoneNumber: 2157627916
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/23/2019
LastUpdateDate: 07/23/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMT219536PAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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