Provider Demographics
NPI:1598757619
Name:TREUTH, MARK GREGORY
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:GREGORY
Last Name:TREUTH
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:GREG
Other - Middle Name:
Other - Last Name:TREUTH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:100 E CARROLL ST
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-5422
Mailing Address - Country:US
Mailing Address - Phone:800-749-5191
Mailing Address - Fax:410-630-7685
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 605
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:410-334-2227
Practice Address - Fax:410-334-3962
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054879174400000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDF62105Medicare UPIN