Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Mark Anthony Bergonia Ison, CRNP-PMH

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1881152783

Mr. Mark Anthony Bergonia Ison, CRNP-PMH is a Nurse Practitioner in Baltimore, Maryland. Qualified in 2018, 8 years ago. Practices with Wellness Legacy LLC, a 4-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Maryland.

Years since qualifying
8
Licensed in
MD
In the registry since
2019
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Practice location Address checks out

1501 Sulgrave Ave Ste 200
Baltimore, MD 21209-3650
Phone: (443) 708-5856
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence R181848 (MD)

Record details

NPI number1881152783
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNP-PMH
Sole proprietorNo
NPI enumeratedMarch 9, 2019
Last updated in NPPESMarch 9, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Wellness Legacy Llc — 4 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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