Provider Demographics
NPI:1154310035
Name:ABBRUZZESE, MARK ROBERT
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ROBERT
Last Name:ABBRUZZESE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11608 CAPLINGER RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2768
Mailing Address - Country:US
Mailing Address - Phone:301-622-9161
Mailing Address - Fax:
Practice Address - Street 1:6400 GOLDSBORO RD
Practice Address - Street 2:SUITE#330
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-5826
Practice Address - Country:US
Practice Address - Phone:301-320-3361
Practice Address - Fax:301-320-0170
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15748207RI0200X
MDD0048226207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC001807K02Medicare ID - Type Unspecified
B92712Medicare UPIN