Provider Demographics
NPI:1952305773
Name:MCBRIDE, MARK A (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:MCBRIDE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:21 HIGHLAND AVE SE
Mailing Address - Street 2:STE 100
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24013-2218
Mailing Address - Country:US
Mailing Address - Phone:540-344-9213
Mailing Address - Fax:540-345-7559
Practice Address - Street 1:21 HIGHLAND AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24013-2218
Practice Address - Country:US
Practice Address - Phone:540-344-9213
Practice Address - Fax:540-345-7559
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-11-17
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Provider Licenses
StateLicense IDTaxonomies
VA0101051297208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA080286000OtherSOUTHERN HEALTH
VA236880OtherMAMSI
VA5058981001OtherCIGNA
VA281060OtherANTHEM
VA54088505610OtherJOHN DEERE
VA4509836OtherAETNA
VA006714153Medicaid