Individual
DR. MARK ALAN IMMERGUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6000 EXECUTIVE BLVD, SUITE 300, ROCKVILLE, MD 20852-3803
(301) 468-8999
Mailing address
6000 EXECUTIVE BLVD, SUITE 300, ROCKVILLE, MD 20852-3803
(301) 468-8999
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
D0008736
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0715414
CIGNA PROVIDER NUMBER
MD
01
—
312564
OPTIMUM CHOICE PROVIDER #
MD
01
—
521186611
UNITED HEALTHCARE PROV #
MD
01
—
V746 0014
BSDC
DC
01
—
V746 0014
BSMD
MD
Enumeration date
04/28/2006
Last updated
04/26/2011
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