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General NPI Number Information
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NPI Number | 1033100284
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Entity Type | Individual
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Provider Name | MARK CARLTON ROUNSAVILLE MD
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Gender | Male
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Dates
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Enumeration Date | 11/04/2005
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 45 LOS PINOS
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City | NICASIO
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State | CA
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Zip | 94946
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Country | US
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Telephone | 415-662-2669
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Fax | 415-662-2669
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Provider Business Mailing Address
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Address Line | 45 LOS PINOS
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City | NICASIO
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State | CA
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Zip | 94946
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Country | US
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Telephone | 415-662-2669
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Fax | 415-662-2669
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | A39060
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License Number State | CA
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