Provider Demographics
NPI:1508980459
Name:DAVINO, MARK H (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:DAVINO
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 1:1106 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1637
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1106 ANNAPOLIS RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-1647
Practice Address - Country:US
Practice Address - Phone:410-874-1400
Practice Address - Fax:410-874-1411
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD67558207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine