Provider Demographics
NPI:1255495800
Name:SIMKO, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SIMKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34656-0428
Mailing Address - Country:US
Mailing Address - Phone:727-841-4200
Mailing Address - Fax:813-443-8135
Practice Address - Street 1:1106 DRUID RD S
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3846
Practice Address - Country:US
Practice Address - Phone:727-584-6266
Practice Address - Fax:727-266-4972
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1590332084P0800X
NJ492602084P0800X
FLME00646062084P0800X
SC166732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
208000OtherMVP HEALTH PLAN
208000OtherMVP HEALTH PLAN
53527BMedicare ID - Type Unspecified