Provider Demographics
NPI:1710100474
Name:GARZON, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GARZON
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 1:2015 SPRING RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-3944
Mailing Address - Country:US
Mailing Address - Phone:630-725-2700
Mailing Address - Fax:
Practice Address - Street 1:1910 TOWNE CENTRE BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3598
Practice Address - Country:US
Practice Address - Phone:410-571-8525
Practice Address - Fax:410-571-8526
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD32949207Q00000X
VA0101243799202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD185228YA20Medicare PIN
VADG0518Medicare PIN
VAP01119629Medicare PIN
VAG01618Medicare PIN
VAP00907625Medicare PIN
MDP01119629Medicare UPIN
MD339LMedicare PIN
VAC10441Medicare PIN
P00888652Medicare PIN
VA182255D18Medicare PIN
VAVAA102391Medicare PIN
MDDG0518Medicare PIN