Provider Demographics
NPI:1649339383
Name:GERNERD, MARK DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:GERNERD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:1506 VALLEY VIEW DR
Mailing Address - City:GWYNEDD VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19437-0534
Mailing Address - Country:US
Mailing Address - Phone:215-699-3943
Mailing Address - Fax:215-699-6027
Practice Address - Street 1:101 BROAD STREET
Practice Address - Street 2:SAINT CATHERINE MEDICAL CENTER FOUNTAIN SPRINGS
Practice Address - City:ASHLAND
Practice Address - State:PA
Practice Address - Zip Code:17921
Practice Address - Country:US
Practice Address - Phone:570-875-5850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020620E207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA597586OtherTPI GROUP MEDICARE PTAN
PA1007278000OtherTPI GROUP MEDICAID ID
PACD4829OtherTPI GROUP RAILROAD MEDICARE