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NPI Code Detail

MEDICARE: DR. MARK STANLEY WASSERMAN MD

MEDICARE: DR. MARK STANLEY WASSERMAN MD
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
1207V00000XObstetrics & Gynecology PhysicianR2F91MO
2207V00000XObstetrics & Gynecology Physician036104995IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225130933
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK STANLEY WASSERMAN MD
Provider Business Mailing Address
First Line : PO BOX 959318
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63195-9318
Country : US
Telephone Number : 573-756-6751
Fax Number : 573-756-6807
Provider Business Practice Location Address
First Line : 965 MATTOX DR
Second Line :
City : SULLIVAN
State : MO
Zip : 63080-2365
Country : US
Telephone Number : 573-860-6000
Fax Number : 573-860-6016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2006
Last Update Date : 09/17/2025

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Directions to “ DR. MARK STANLEY WASSERMAN MD” Practice Location

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