Provider Demographics
NPI:1093790024
Name:ACIERNO, MARK ROBERTO (PT, DPT, OCS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERTO
Last Name:ACIERNO
Suffix:
Gender:M
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 GLEN HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5806
Mailing Address - Country:US
Mailing Address - Phone:301-631-6841
Mailing Address - Fax:
Practice Address - Street 1:84 THOMAS JOHNSON CT
Practice Address - Street 2:SUITE B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4348
Practice Address - Country:US
Practice Address - Phone:301-662-8541
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18941208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD334552OtherPHCS
MD604235-02OtherCAREFIRST
MDK1340004OtherMSS BC
MD2004876OtherUHC FSS
MD443703OtherMSS MAMSI
MD604235-03OtherMSS CAREFIRST
MDR5590001OtherFSS BC FEP
MD2511558OtherUHC MSS
MD551810OtherFSS MAMSI
MD604235-02OtherCAREFIRST
MDK1340004OtherMSS BC
MD604235-03OtherMSS CAREFIRST