Provider Demographics
NPI:1679688204
Name:KRASNA, MARK JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JONATHAN
Last Name:KRASNA
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 1:3519 BARTON OAKS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-4332
Mailing Address - Country:US
Mailing Address - Phone:410-427-2220
Mailing Address - Fax:410-427-2221
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:O'DEA MEDICAL ARTS BLDG. SUITE 303
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-427-2220
Practice Address - Fax:410-427-2221
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00402922086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE66220Medicare UPIN
MDO794Medicare PIN