Provider Demographics
NPI:1548214372
Name:DEBLOIS, MARK EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWIN
Last Name:DEBLOIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1115 BOULDERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4067
Mailing Address - Country:US
Mailing Address - Phone:804-560-5595
Mailing Address - Fax:804-560-9029
Practice Address - Street 1:1115 BOULDERS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23225-4067
Practice Address - Country:US
Practice Address - Phone:804-320-1339
Practice Address - Fax:804-330-5829
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2013-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA101036512207XS0114X
VA0101036512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061547OtherANTHEM HEALTHKEEPERS PLUS
VA061547OtherANTHEM
VA540885859OtherC&O EMPLOYEES HOSP ASSO
VA540885859OtherFARA
VA006440193Medicaid
VA2138265OtherUNITED HEALTH CARE MAMSI
VA540885859OtherFOCUS
VA540885859OtherMULTIPLAN
VA540885859OtherCENVANET
VA1548214372Medicaid
VA536767OtherAETNA/US HMO
VA540885859OtherPHCS
VA540885859OtherCIGNA
VA540885859OtherCOMPMANAGEMENT
VA200019198OtherRR MEDICARE
VA48192OtherOPTIMA HEALTH
VA540885859OtherCORVEL
VA540885859OtherFIRST HEALTH/CCN
VAB60082Medicare UPIN
VA540885859OtherPHCS
VA540885859OtherCOMPMANAGEMENT