Provider Demographics
NPI:1922167394
Name:AGRESTI, MARK GEORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GEORGE
Last Name:AGRESTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2010 CONTINENTAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-3236
Mailing Address - Country:US
Mailing Address - Phone:561-842-9550
Mailing Address - Fax:561-842-9114
Practice Address - Street 1:2010 CONTINENTAL DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-3236
Practice Address - Country:US
Practice Address - Phone:561-842-9550
Practice Address - Fax:561-842-9114
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME604602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371191900Medicaid
FL371191900Medicaid