Provider Demographics
NPI:1508425877
Name:GINGERICH, JOHN MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN MARK
Middle Name:ANDREW
Last Name:GINGERICH
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 1:213 2ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:ND
Mailing Address - Zip Code:58367-7153
Mailing Address - Country:US
Mailing Address - Phone:701-477-3161
Mailing Address - Fax:
Practice Address - Street 1:213 2ND AVE NE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:ND
Practice Address - Zip Code:58367-7153
Practice Address - Country:US
Practice Address - Phone:701-477-3161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NDPT20193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program