Individual
DR. MARK ALAN IMMERGUT
Active
Individual
DR. MARK ALAN IMMERGUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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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