Mark a Eberbach MD PA

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

ME0048142 Issued in FL

Legal business name

MARK A EBERBACH MD PA

Practice address

14012 US Highway 19
Hudson, FL 34667-1165

Phone

(727) 868-4490

Fax

(727) 869-7085

NPI assigned

Aug 18, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark Allen Eberbach, MDNPI 1750386744

Title

President

Phone

(727) 868-4490

Specialties & licenses 1

Addresses

Other identifiers 3

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Allen Eberbach, MD

  • Specialist
  • Hudson, FL
  • NPI 1750386744
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1237161600000",
    "number": "1124274493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14012 US HIGHWAY 19",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "346671165",
            "telephone_number": "727-868-4490",
            "fax_number": "727-869-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14012 US HIGHWAY 19",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "346671165",
            "telephone_number": "727-868-4490",
            "fax_number": "727-869-7085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK A EBERBACH MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-18",
        "last_updated": "2009-03-16",
        "status": "A",
        "authorized_official_last_name": "EBERBACH",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "727-868-4490",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "FL",
            "license": "ME0048142",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "07923",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UPIN",
            "identifier": "E31250",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "K5399",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Monique Mangini
• Dawn Marie Marazzi
• Susan Mardjetko
• Maria C Soto-Aguilar M D P a
• Samantha Marina, MS, RD, LDN
• Mark Alagna MD PA
• Julie Miller Marriott
• Marshall M. Desantis, M.D.,PA
• Laurence J Martin, M.D.
• Sherry Ann Martin, LMT

• Ambulatory Surgical Clinic/Center in Hudson, FL
• Providers in Hudson, FL by specialty
• Ambulatory Surgical Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.