Provider Demographics
NPI:1427335553
Name:GUGGENHEIM, MARK MEIR (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:MEIR
Last Name:GUGGENHEIM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 / 3 ALIYAT HANOAR STREET
Mailing Address - Street 2:
Mailing Address - City:JERUSALEM
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:97234
Mailing Address - Country:IL
Mailing Address - Phone:410-946-9518
Mailing Address - Fax:
Practice Address - Street 1:6711 PARK HEIGHTS AVE APT 109
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-2476
Practice Address - Country:US
Practice Address - Phone:410-946-9518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD767 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist