Van Dyke, Mark William

Van Dyke, Mark William is an individual health care provider with primary practice located at 306 W 11Th St 2Nd Fl , Erie PA 16501-1705. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Emergency Medical Services, Allopathic & Osteopathic Physicians / Occupational Medicine, Allopathic & Osteopathic Physicians / Addiction Medicine. Allopathic & Osteopathic Physicians / Addiction Medicine is his primary health care specialty. Van Dyke, Mark William can be contacted via phone (814) 240-6216.

Contact Information

Primary practice address
306 W 11Th St 2Nd Fl Erie PA 16501-1705
Phone: (814) 240-6216
Fax: (814) 240-6219
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medical Services 207PE0004X OS006067E Pennsylvania
Allopathic & Osteopathic Physicians / Occupational Medicine 2083X0100X OS006067E Pennsylvania
Allopathic & Osteopathic Physicians / Addiction Medicine 207RA0401X OS006067E Pennsylvania

Profile Details

NPI number 1407906613
LBN Legal business name Van Dyke, Mark William
Credentials Doctor of Osteopathy (DO)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2007
Last updated Apr 10th, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407906613 NPPES
Pennsylvania MEDICAID 0011147300006

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