Provider Demographics
NPI:1750431433
Name:UNGSON, NICK MARON (MD)
Entity type:Individual
Prefix:DR
First Name:NICK
Middle Name:MARON
Last Name:UNGSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:33057 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34788-7506
Mailing Address - Country:US
Mailing Address - Phone:352-787-0081
Mailing Address - Fax:352-314-9444
Practice Address - Street 1:33057 PROFESSIONAL DR
Practice Address - Street 2:SUITE 102
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34788-7506
Practice Address - Country:US
Practice Address - Phone:352-787-0081
Practice Address - Fax:352-314-9444
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME720892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG62805Medicare UPIN
FL42245AMedicare ID - Type UnspecifiedROVIDER NUMBER