Provider Demographics
NPI:1023132867
Name:HEALTHMARK, INCORPORATED
Entity type:Organization
Organization Name:HEALTHMARK, INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDERMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:215-952-9900
Mailing Address - Street 1:1CRESCENT DR.
Mailing Address - Street 2:NAVY YARD SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19112
Mailing Address - Country:US
Mailing Address - Phone:215-952-9900
Mailing Address - Fax:215-952-9977
Practice Address - Street 1:1 CRESCENT DR.
Practice Address - Street 2:NAVY YARD SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19112
Practice Address - Country:US
Practice Address - Phone:215-952-9900
Practice Address - Fax:215-952-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD058825L261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA72118OtherPHYSICIAN ASSISTANT
PA72118OtherPHYSICIAN ASSISTANT