Healthcare Provider Details

I. General information

NPI: 1912015462
Provider Name (Legal Business Name): MARK L. PALMERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SUTTER PLACE
DAVIS CA
95616-6201
US

IV. Provider business mailing address

2100 POWELL ST STE 900
EMERYVILLE CA
94608-1844
US

V. Phone/Fax

Practice location:
  • Phone: 530-756-6440
  • Fax:
Mailing address:
  • Phone: 510-350-2842
  • Fax: 510-879-9128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberC50942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: