Provider Demographics
NPI:1386661155
Name:UGARTE, MARCOS A (MD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:A
Last Name:UGARTE
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 1:401 ALLEGHENY AVE
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1949
Mailing Address - Country:US
Mailing Address - Phone:717-630-2844
Mailing Address - Fax:717-630-2834
Practice Address - Street 1:401 ALLEGHENY AVE
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1949
Practice Address - Country:US
Practice Address - Phone:717-630-2844
Practice Address - Fax:717-630-2834
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052860L174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01102001OtherCAPITAL BLUE CROSS
PA01482530Medicaid
PA114970OtherUNISON
PA991821OtherKEYSTONE HEALTH PLAN
PAUG439130OtherHIGHMARK BLUE SHIELD
PA1519061OtherGATEWAY
PAF88185Medicare UPIN
PA1519061OtherGATEWAY