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NPI Code Detail

MEDICARE: DR. RON MARK M.D.

MEDICARE: DR. RON MARK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12085R0202XDiagnostic Radiology Physician36126885IL
22085R0202XDiagnostic Radiology Physician214773NY
32085R0202XDiagnostic Radiology PhysicianTM2010-0634NM

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00221729OTHERNYRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1013917301
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RON MARK M.D.
Provider Business Mailing Address
First Line : 2103 DEER PARK AVE
Second Line :
City : DEER PARK
State : NY
Zip : 11729-1319
Country : US
Telephone Number : 631-574-2060
Fax Number :
Provider Business Practice Location Address
First Line : 2103 DEER PARK AVE
Second Line :
City : DEER PARK
State : NY
Zip : 11729-1319
Country : US
Telephone Number : 631-574-2060
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/28/2005
Last Update Date : 06/17/2025

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