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NPI Code Detail

MEDICARE: MARK EUGENE UNGER CRNA

MEDICARE: MARK EUGENE UNGER CRNA
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
1163W00000XRegistered NurseRN-240389-LPA
2367500000XCertified Registered Nurse Anesthetist035827PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10853638OTHERPAHIGHMARK

General Provider Information

NPI Number : 1760484877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK EUGENE UNGER CRNA
Provider Business Mailing Address
First Line : 3812 LISA LN
Second Line :
City : COLLEGEVILLE
State : PA
Zip : 19426-3052
Country : US
Telephone Number : 610-489-2164
Fax Number :
Provider Business Practice Location Address
First Line : 123 W GERMANTOWN PIKE
Second Line : SUITE 2
City : EAST NORRITON
State : PA
Zip : 19401-1382
Country : US
Telephone Number : 610-278-7456
Fax Number : 610-278-7457
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 08/09/2011

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