Healthcare Provider Details

I. General information

NPI: 1760484877
Provider Name (Legal Business Name): MARK EUGENE UNGER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 W GERMANTOWN PIKE SUITE 2
EAST NORRITON PA
19401-1382
US

IV. Provider business mailing address

3812 LISA LN
COLLEGEVILLE PA
19426-3052
US

V. Phone/Fax

Practice location:
  • Phone: 610-278-7456
  • Fax: 610-278-7457
Mailing address:
  • Phone: 610-489-2164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number035827
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN-240389-L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: