Provider Demographics
NPI:1740393560
Name:MARK A. DEITCH, MD, LLC
Entity Type:Organization
Organization Name:MARK A. DEITCH, MD, LLC
Other - Org Name:MD3 ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-296-4494
Mailing Address - Street 1:6535 N CHARLES ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21204-5826
Mailing Address - Country:US
Mailing Address - Phone:410-296-4494
Mailing Address - Fax:410-296-4493
Practice Address - Street 1:6535 N CHARLES ST
Practice Address - Street 2:SUITE 425
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5826
Practice Address - Country:US
Practice Address - Phone:410-296-4494
Practice Address - Fax:410-296-4493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty