Provider Demographics
NPI:1942332267
Name:CORMAN, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:CORMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3309 S KINGSHIGHWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-1101
Mailing Address - Country:US
Mailing Address - Phone:314-206-3700
Mailing Address - Fax:314-206-3708
Practice Address - Street 1:1150 GRAHAM RD STE 102
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-8077
Practice Address - Country:US
Practice Address - Phone:314-206-3900
Practice Address - Fax:314-206-3992
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2024-01-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0431293208D00000X
MO20100061542084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice