Mark J Funt, DMD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

DS019726L Issued in PA

Practice address

401 Township Line Rd
Ste C
Elkins Park, PA 19027-2202

Phone

(215) 379-5520

Fax

(215) 663-5934

NPI assigned

Oct 12, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

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.

• Greater Philadelphia Oral Surgery PC

  • Oral & Maxillofacial Surgery (D.M.D.)
  • Elkins Park, PA
  • NPI 1366549594
  Medicare reassignment NPD
• Greater Philadelphia Oms LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Elkins Park, PA
  • NPI 1699698936
  NPD (past)

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211500800000",
    "number": "1407945280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 TOWNSHIP LINE RD",
            "address_2": "STE C",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272202",
            "telephone_number": "215-379-5520",
            "fax_number": "215-663-5934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 TOWNSHIP LINE RD",
            "address_2": "STE C",
            "city": "ELKINS PARK",
            "state": "PA",
            "postal_code": "190272202",
            "telephone_number": "215-379-5520",
            "fax_number": "215-663-5934"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNT",
        "first_name": "MARK",
        "middle_name": "J",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-12",
        "last_updated": "2008-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "PA",
            "license": "DS019726L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• J Lamar Freed, PSY.D
• Marsha J Friedman, PHD
• Renee Darcell Frierson-Briscoe, LPC, LMFT
• Victor I Friesen, PHD
• Lindsay Fruehauf
• Erin Gaffney, OTD, OTR/L
• Carolyn Denise Galbally
• Joan H. Gallagher, LSW
• Darla Annette Gallo
• Anuradha Ganta, DR

• Oral & Maxillofacial Surgery (D.M.D.) in Elkins Park, PA
• Providers in Elkins Park, PA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; 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.