Provider Demographics
NPI:1760484877
Name:UNGER, MARK EUGENE (CRNA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:EUGENE
Last Name:UNGER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3812 LISA LN
Mailing Address - Street 2:
Mailing Address - City:COLLEGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19426-3052
Mailing Address - Country:US
Mailing Address - Phone:610-489-2164
Mailing Address - Fax:
Practice Address - Street 1:123 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 2
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19401-1382
Practice Address - Country:US
Practice Address - Phone:610-278-7456
Practice Address - Fax:610-278-7457
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN-240389-L163W00000X
PA035827367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0853638OtherHIGHMARK
PA0853638OtherHIGHMARK