1649339383 NPI number — DR. MARK DAVID GERNERD MD

Table of content: DR. MARK DAVID GERNERD MD (NPI 1649339383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649339383 NPI number — DR. MARK DAVID GERNERD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GERNERD
Provider First Name:
MARK
Provider Middle Name:
DAVID
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649339383
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 534
Provider Second Line Business Mailing Address:
1506 VALLEY VIEW DR
Provider Business Mailing Address City Name:
GWYNEDD VALLEY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19437-0534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-699-3943
Provider Business Mailing Address Fax Number:
215-699-6027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 BROAD STREET
Provider Second Line Business Practice Location Address:
SAINT CATHERINE MEDICAL CENTER FOUNTAIN SPRINGS
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
570-875-5850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  MD020620E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 597586 . This is a "TPI GROUP MEDICARE PTAN" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007278000 . This is a "TPI GROUP MEDICAID ID" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CD4829 . This is a "TPI GROUP RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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