Individual provider Active NPI

Mark F Victor, MD

  • Cardiovascular Disease Physician
  • Philadelphia, PA
National Provider Identifier
1770557050
Registry record updated May 23, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD019607E Issued in PA
Practice address
1703 S Broad St
Suite 300
Philadelphia, PA 19148
Phone
(215) 463-5333
Fax
(215) 463-8085
NPI assigned
Feb 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD019607E PA Primary

Addresses

Primary practice location

1703 S Broad St
Suite 300
Philadelphia, PA 19148

Mailing address

207 N Broad St
3Rd FLR.
Philadelphia, PA 19107-1500
Phone (267) 479-4142

Other practice location 1

227 N Broad St Ste 200
Philadelphia, PA 19107-1503
Phone (215) 564-3050

Other identifiers 1

IdentifierTypeStateIssuer
000996145MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101109001346 PA Practitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8224002217 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Associates in Healthcare, Inc CurrentSince Sep 1, 2017 Accepting new patients
Methodist Associates in Healthcare, Inc CurrentSince Sep 1, 2017 Accepting new patients
Prime Healthcare Services-Roxborough Providers LLC Past Accepting new patients

Locations

227 N Broad St
Ste 200
Philadelphia, PA 19107
Phone (215) 564-3050

111 S 11th St
Ste 8490
Philadelphia, PA 19107
Phone (215) 955-6161

1703 S Broad St
Ste 300
Philadelphia, PA 19148
Phone (215) 462-7100

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1139875200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527033600000",
    "number": "1770557050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 N BROAD ST",
            "address_2": "3RD FLR.",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191071500",
            "telephone_number": "267-479-4142",
            "fax_number": "215-463-3820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 S BROAD ST",
            "address_2": "SUITE 300",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19148",
            "telephone_number": "215-463-5333",
            "fax_number": "215-463-8085"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "227 N Broad St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191071503",
            "country_code": "US",
            "telephone_number": "215-564-3050",
            "fax_number": "215-564-3398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VICTOR",
        "first_name": "MARK",
        "middle_name": "F",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-14",
        "last_updated": "2018-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "PA",
            "license": "MD019607E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000996145",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.