Provider Demographics
NPI:1447233218
Name:LIGNELL, MARK DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DOUGLAS
Last Name:LIGNELL
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:USNH
Mailing Address - Street 2:PSC 475 BOX 1837 FPO AP 96350
Mailing Address - City:JOKOSULA
Mailing Address - State:YOKOSUKA
Mailing Address - Zip Code:96350
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USNH
Practice Address - Street 2:PSC 475 BOX 1837 FPO AP 96350
Practice Address - City:YOKOSUKA
Practice Address - State:YOKOSUKA
Practice Address - Zip Code:96350
Practice Address - Country:JP
Practice Address - Phone:0118146-896-4949
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101230994207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology