Provider Demographics
NPI:1063463560
Name:DEITCH, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:DEITCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2700 QUARRY LAKE DR
Mailing Address - Street 2:#300
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3746
Mailing Address - Country:US
Mailing Address - Phone:410-377-8900
Mailing Address - Fax:410-377-3156
Practice Address - Street 1:2700 QUARRY LAKE DR
Practice Address - Street 2:#300
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3746
Practice Address - Country:US
Practice Address - Phone:410-377-8900
Practice Address - Fax:410-377-3156
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-02-13
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Provider Licenses
StateLicense IDTaxonomies
MDD54458207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD115507500Medicaid
MD115507500Medicaid