Provider Demographics
NPI:1821082892
Name:MARK, MICHAEL H (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:MARK
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 1:28467 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-3749
Mailing Address - Country:US
Mailing Address - Phone:302-933-0111
Mailing Address - Fax:302-933-0990
Practice Address - Street 1:28467 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-3749
Practice Address - Country:US
Practice Address - Phone:302-933-0111
Practice Address - Fax:302-933-0990
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-00035412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
51038312COtherBLUE SHIELD DE
265039OtherMAMSI
4275007OtherAETNA
D000288OtherTRICARE
KG82OtherMD BLUE SHIELD
C08438OtherMID ATLANTIC
DE0000245501Medicaid
130018400OtherRAILROAD MEDICARE
G2420004OtherDELMARVA HEALTH PLAN
51038312COtherBLUE SHIELD DE
DE0000245501Medicaid