Provider Demographics
NPI:1922834555
Name:PLACHKOV, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PLACHKOV
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2424 E YORK ST STE 100-M
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3026
Mailing Address - Country:US
Mailing Address - Phone:445-304-9050
Mailing Address - Fax:
Practice Address - Street 1:2424 E YORK ST STE 100-M
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3026
Practice Address - Country:US
Practice Address - Phone:445-304-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)