1942260088 NPI number — MARK GARCIA MD

Table of content: MARK GARCIA MD (NPI 1942260088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942260088 NPI number — MARK GARCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARCIA
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
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:
1942260088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 N. CLAYTON ST.
Provider Second Line Business Mailing Address:
SUITE 601 MSB
Provider Business Mailing Address City Name:
WILMINGTON
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19805-2171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-760-9002
Provider Business Mailing Address Fax Number:
302-482-1333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N. CLAYTON ST.
Provider Second Line Business Practice Location Address:
SUITE 601 MSB
Provider Business Practice Location Address City Name:
WILMINGTON
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-760-9002
Provider Business Practice Location Address Fax Number:
302-482-1333
Provider Enumeration Date:
03/24/2006

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: 2085R0202X , with the licence number:  C1-0004350 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: C1-0004350 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0000797301 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300082183 . This is a "RAILROAD MEDICARE #" identifier . This identifiers is of the category "OTHER".




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