Provider Demographics
NPI:1649211913
Name:DORAN, MARK P (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:DORAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 INDEPENDENCE PT STE 212
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4536
Mailing Address - Country:US
Mailing Address - Phone:864-797-6308
Mailing Address - Fax:
Practice Address - Street 1:701 GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29605-4210
Practice Address - Country:US
Practice Address - Phone:864-455-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3471207P00000X
SC1660207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0271808000OtherAMERIHEALTH 65PA GH
PA207315OtherJOHNS HOPKINS
PA20078681OtherAMERIHEALTH MERCY-WMG
PA246997OtherUNISON-WMG
PA101554703Medicaid
PA50080287OtherCAPITAL BLUE CROSS-WMG
PA9363086OtherAETNA
PA1551162OtherGATEWAY GH
PA1839839OtherHIGHMARK GH
PA101005OtherGEISINGER-GH
PA20057348OtherAMERIHEALTH MERCY GH
PA246995OtherUNISON-GH
PA50067125OtherCAPITAL BLUE CROSS GH
PA1839839OtherHIGHMARK GH
PA9363086OtherAETNA
PA1551162OtherGATEWAY GH
PAP00724765Medicare PIN