Provider Demographics
NPI:1285659185
Name:ZWANGER, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ZWANGER
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 1:15 BAYSIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:BETTERTON
Mailing Address - State:MD
Mailing Address - Zip Code:21610-9701
Mailing Address - Country:US
Mailing Address - Phone:215-704-2818
Mailing Address - Fax:215-440-8689
Practice Address - Street 1:15 BAYSIDE BLVD
Practice Address - Street 2:
Practice Address - City:BETTERTON
Practice Address - State:MD
Practice Address - Zip Code:21610-9701
Practice Address - Country:US
Practice Address - Phone:215-704-2818
Practice Address - Fax:215-440-8689
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041325E207P00000X
MDD0066934207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6396003Medicaid
PA001123909Medicaid
NJ6396003Medicaid