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Individual

MARC IMMERMAN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1003 WALNUT ST, ELMIRA, NY 14901-1007
(607) 732-5646
(607) 732-0373
Mailing address
1003 WALNUT ST, ELMIRA, NY 14901-1007
(607) 732-5646
(607) 732-0373

Taxonomy

Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
174214
NY
208D00000X
General Practice Physician
Primary
174214
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000915192004
BCBS
NY
05
01144467
NY
Enumeration date
08/09/2006
Last updated
02/06/2018
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