Mark D Widome, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

MD015734E Issued in PA

Practice address

35 Hope Dr
Suite 102
Hershey, PA 17033-2086

Phone

(717) 531-7300

Fax

(717) 531-3527

NPI assigned

May 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

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 Medicine

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.

• The Milton S Hershey Medical Center Physicians Group

  • Orthopaedic Surgery Physician
  • Hershey, PA
  • NPI 1710951744
  Medicare reassignment NPD
• The Milton S Hershey Medical Center Physician Group

  • Body Imaging Physician
  • Hershey, PA
  • NPI 1346215928
  NPD
• The Milton S Hershey Medical Center Physicians Group

  • Pediatrics Physician
  • Hershey, PA
  • NPI 1205801537
  NPD

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

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1558311191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 UNIVERSITY DR",
            "address_2": "MC A410",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332360",
            "telephone_number": "800-531-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 HOPE DR",
            "address_2": "SUITE 102",
            "city": "HERSHEY",
            "state": "PA",
            "postal_code": "170332086",
            "telephone_number": "717-531-7300",
            "fax_number": "717-531-3527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDOME",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-12",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "PA",
            "license": "MD015734E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006670110007",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Marie Whitman
• Larissa Dawn Whitney, PA-C
• Holly Whitt
• Wholecare Integrated Services
• Kristine Lee Widders, M.D.
• Andrew Robert Wiener, DO
• Jessica Lynn Wilcox, PHARMD
• Steven Russell Wilding, M.D.
• Grace Anne Wilgucki, DO
• Caroline Wilhelm, CRNP

• Pediatrics Physician in Hershey, PA
• Providers in Hershey, PA by specialty
• Pediatrics Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; 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.