Mark William Van Dyke, DO

Primary specialty

Addiction Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0401X

License

OS006067E Issued in PA

Practice address

306 W 11TH St 2ND FL
Erie, PA 16501-1705

Phone

(814) 240-6216

Fax

(814) 240-6219

NPI assigned

Jan 11, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Epn Hamot Urgent Care LLC

  • Family Medicine Physician
  • Erie, PA
  • NPI 1518283753

  Occupational Medicine

  Medicare reassignment NPD
• Regional Health Services Inc

  • Family Medicine Physician
  • Erie, PA
  • NPI 1174520654
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523318400000",
    "number": "1407906613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 W 11TH ST",
            "address_2": "2ND FLOOR",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011746",
            "telephone_number": "814-240-6216",
            "fax_number": "814-240-6219"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "306 W 11TH ST 2ND FL",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165011705",
            "telephone_number": "814-240-6216",
            "fax_number": "814-240-6219"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN DYKE",
        "first_name": "MARK",
        "middle_name": "WILLIAM",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-11",
        "last_updated": "2018-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "PA",
            "license": "OS006067E",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "PA",
            "license": "OS006067E",
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": "PA",
            "license": "OS006067E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011147300006",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kevin Charles Valasek, DC
• Kellie Lee Valentine
• Randall L Valentine, DMD MSD
• Joshua Richard Valerio, DO
• Dennis Robert Valone, ED.D.
• Clinton F Van Hoff
• Erin Marie Van Iderstine, MS, NBCC, LPC
• Breanna Marie Van Loon
• Leah Vanarsdale, PA
• Dominic Vanchieri, DO

• Addiction Medicine (Internal Medicine) Physician in Erie, PA
• Providers in Erie, PA by specialty
• Addiction Medicine (Internal Medicine) Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.