Provider Demographics
NPI:1487670634
Name:DENZINE, MARK LOREN (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOREN
Last Name:DENZINE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MEDICAL PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3743
Mailing Address - Country:US
Mailing Address - Phone:410-268-8862
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE # A41
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-3927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH84961207XS0114X
OH34.012790207X00000X
PAOT014667207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Single Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA019967A47Medicare PIN
25090065OtherBLUE CROSS BLUE SHIELD ID
148820100OtherDEPT OF LABOR ID
VAQ38774Medicare UPIN