Provider Demographics
NPI:1619959285
Name:SIMMONS, MARK LINWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LINWOOD
Last Name:SIMMONS
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 1:2110 HARRISBURG PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-2644
Mailing Address - Country:US
Mailing Address - Phone:717-544-3191
Mailing Address - Fax:717-544-3637
Practice Address - Street 1:2110 HARRISBURG PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-2644
Practice Address - Country:US
Practice Address - Phone:717-544-3191
Practice Address - Fax:717-544-3637
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD064373L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAI71009OtherHEALTH AMERICA
PA1947245OtherHIGHMARK BLUE SHIELD
PA107756 S1QAOtherGEISINGER HEALTH PLAN
PA1018709640001Medicaid
PA1574107OtherAETNA HMO
PA50066312OtherCAPITAL BLUE CROSS
PA7167924OtherAETNA NON-HMO
PA109181G21Medicare PIN
PAI71009Medicare UPIN