Provider Demographics
NPI:1659303774
Name:SCARUPA, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SCARUPA
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 1:11002 VEIRS MILL RD
Mailing Address - Street 2:414
Mailing Address - City:WHEATON
Mailing Address - State:MD
Mailing Address - Zip Code:20902-2574
Mailing Address - Country:US
Mailing Address - Phone:301-962-1605
Mailing Address - Fax:
Practice Address - Street 1:11002 VEIRS MILL RD
Practice Address - Street 2:414
Practice Address - City:WHEATON
Practice Address - State:MD
Practice Address - Zip Code:20902-2574
Practice Address - Country:US
Practice Address - Phone:301-962-1605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61301207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD02-00863OtherUNITED HEALTHCARE
MD247132OtherKAISER
MD695044OtherNCPPO
MDC4540007OtherCAREFIRST NCA
MD2133588OtherMAMSI
MD7828646OtherAETNA
MD247132OtherKAISER
MDI20696Medicare UPIN