Provider Demographics
NPI:1891752374
Name:DETWEILER, MARK BUDD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BUDD
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1970 ROANOKE BLVD
Mailing Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER, MHSL (116A7)
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-6404
Mailing Address - Country:US
Mailing Address - Phone:540-982-2463
Mailing Address - Fax:540-983-1080
Practice Address - Street 1:1970 ROANOKE BLVD
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER, MHSL (116A7)
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-6404
Practice Address - Country:US
Practice Address - Phone:540-982-2463
Practice Address - Fax:540-983-1080
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2011-06-07
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Provider Licenses
StateLicense IDTaxonomies
VA01012345792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry