Individual
MR. MARK ANTHONY BERGONIA ISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP- PMH
Contact information
Practice address
1501 SULGRAVE AVE STE 200, BALTIMORE, MD 21209-3650
(443) 708-5856
Mailing address
1501 SULGRAVE AVE STE 200, BALTIMORE, MD 21209-3650
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R181848
MD
Other
Enumeration date
03/09/2019
Last updated
03/09/2019
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