Provider Demographics
NPI:1629224688
Name:DUMONSKI, MARK LEONARD (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:LEONARD
Last Name:DUMONSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1915 LENDEW STREET
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408
Mailing Address - Country:US
Mailing Address - Phone:336-275-3325
Mailing Address - Fax:336-275-5346
Practice Address - Street 1:1915 LENDEW STREET
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-275-3325
Practice Address - Fax:336-275-5346
Is Sole Proprietor?:No
Enumeration Date:2008-08-11
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2010-00367207X00000X, 207XS0117X
IL125-0474632207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915487Medicaid
NC2010-00367OtherNC MEDICAL BOARD
NC2076302Medicare PIN