Provider Demographics
NPI:1073515813
Name:RADOWICH, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:RADOWICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 235
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2770
Mailing Address - Fax:410-841-6251
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 235
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-2770
Practice Address - Fax:410-841-6251
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00380712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD723COtherAAD SHIPLEYS
MDA08OtherAAD PG COUNTY
MDU399OtherAAD AA COUNTY
MD8317071OtherAETNA PPO
MD2622593OtherAETNA HMO/POS
MD300014357OtherTRAVELERS RR MEDICARE
MD530391500Medicaid
MD10690016OtherBCBS
MD2622593OtherAETNA HMO/POS
MDA08OtherAAD PG COUNTY
MD723COtherAAD SHIPLEYS
MD300014357OtherTRAVELERS RR MEDICARE
MDU399OtherAAD AA COUNTY
MD300014357Medicare PIN