Provider Demographics
NPI:1619178092
Name:AVIGAN, MARK ISAAC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ISAAC
Last Name:AVIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:502 HERMLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1608
Mailing Address - Country:US
Mailing Address - Phone:301-681-5657
Mailing Address - Fax:
Practice Address - Street 1:10903 NEW HAMPSHIRE AVE.
Practice Address - Street 2:BLDG 22, RM 3478
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902
Practice Address - Country:US
Practice Address - Phone:301-796-0065
Practice Address - Fax:301-796-9725
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0025991207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology