Provider Demographics
NPI:1265475313
Name:KOURY, MARK HOWELL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWELL
Last Name:KOURY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HIDDENBROOK CT
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:MD
Mailing Address - Zip Code:21131-1845
Mailing Address - Country:US
Mailing Address - Phone:410-592-2646
Mailing Address - Fax:410-592-9879
Practice Address - Street 1:600 MEMORIAL AVE
Practice Address - Street 2:EMERGENCY DEPT.
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3765
Practice Address - Country:US
Practice Address - Phone:301-723-4100
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023052207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD74679Medicare UPIN