Provider Demographics
NPI:1669509477
Name:MARK S. AUSTERLITZ, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:MARK S. AUSTERLITZ, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:S
Authorized Official - Last Name:AUSTERLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-277-9000
Mailing Address - Street 1:7485 MISSION VALLEY RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4422
Mailing Address - Country:US
Mailing Address - Phone:858-277-9000
Mailing Address - Fax:858-819-7101
Practice Address - Street 1:7485 MISSION VALLEY RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4422
Practice Address - Country:US
Practice Address - Phone:858-277-9000
Practice Address - Fax:858-819-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33220207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G332200OtherBLUE SHIELD
CAG33220Medicare ID - Type Unspecified
CA00G332200OtherBLUE SHIELD