Provider Demographics
NPI:1871684472
Name:HERMACINSKI, MARK J (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:HERMACINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:940 CENTRAL PARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8853
Mailing Address - Country:US
Mailing Address - Phone:970-879-9299
Mailing Address - Fax:866-228-0896
Practice Address - Street 1:940 CENTRAL PARK DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8853
Practice Address - Country:US
Practice Address - Phone:970-879-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO35333208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01353333Medicaid
CO01353333Medicaid
COG49821Medicare UPIN