Provider Demographics
NPI:1548245855
Name:DUMAS, MARK N (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:N
Last Name:DUMAS
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 1:5801 BREMO ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226
Mailing Address - Country:US
Mailing Address - Phone:804-285-0620
Mailing Address - Fax:804-285-0726
Practice Address - Street 1:5801 BREMO ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226
Practice Address - Country:US
Practice Address - Phone:804-285-0620
Practice Address - Fax:804-285-0726
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30149207R00000X
VA0101247752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7929371Medicaid
110060522OtherRAILROAD MEDICARE
VA1548245855Medicaid
C83582Medicare UPIN
VAVAA104280Medicare PIN
110060522OtherRAILROAD MEDICARE