Provider Demographics
NPI:1932130242
Name:TOTTEN, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:TOTTEN
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:PO BOX 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:630 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-801-8001
Practice Address - Fax:812-801-8002
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01043806207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200044830AMedicaid
IN412548POtherSIHO
KY64878663Medicaid
KY1063124OtherPASSPORT KY MEDICAID
4673501OtherAETNA
IN000000042201OtherANTHEM BCBS
080099239OtherMEDICARE RAILROAD
KY64878663Medicaid
IN200044830AMedicaid
IN080099239Medicare PIN
IN412850SMedicare ID - Type Unspecified