Provider Demographics
NPI:1720005507
Name:DAM, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DAM
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 1:40 HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4132
Mailing Address - Country:US
Mailing Address - Phone:203-662-8900
Mailing Address - Fax:203-662-8906
Practice Address - Street 1:40 HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4132
Practice Address - Country:US
Practice Address - Phone:203-662-8900
Practice Address - Fax:203-662-8906
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT033665207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF78881Medicare UPIN