Active NPI
Mark Christopher Elisco, D.M.D.
- Dentist
- Hermitage, PA
National Provider Identifier
1316978356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DS030148L
- Practice address
- 3110 Highland Rd
Hermitage, PA 16148-4505 - Phone
- (724) 981-1223
- Fax
- (724) 981-7688
- NPI assigned
- Jul 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DS030148L | PA | Primary |
Addresses
Primary practice location
3110 Highland Rd
Hermitage, PA 16148-4505
Mailing address
3110 Highland Rd
Hermitage, PA 16148-4505
Phone (724) 981-1223
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS030148L | PA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1316978356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3110 HIGHLAND RD",
"city": "HERMITAGE",
"state": "PA",
"postal_code": "161484505",
"telephone_number": "724-981-1223",
"fax_number": "724-981-7688"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3110 HIGHLAND RD",
"city": "HERMITAGE",
"state": "PA",
"postal_code": "161484505",
"telephone_number": "724-981-1223",
"fax_number": "724-981-7688"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELISCO",
"first_name": "MARK",
"middle_name": "CHRISTOPHER",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "PA",
"license": "DS030148L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hermitage, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.