Provider Demographics
NPI:1982690327
Name:DUMAIS, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:DUMAIS
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 1:500 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-5931
Mailing Address - Country:US
Mailing Address - Phone:301-609-4857
Mailing Address - Fax:301-609-4105
Practice Address - Street 1:500 CHARLES ST
Practice Address - Street 2:
Practice Address - City:LA PLATA
Practice Address - State:MD
Practice Address - Zip Code:20646-5931
Practice Address - Country:US
Practice Address - Phone:301-609-4857
Practice Address - Fax:301-609-4105
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053813207R00000X, 2083P0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD135400100Medicaid
60644802OtherBCBS MARYLAND
S3990056OtherBCBS DC
145724700OtherDEPARTMENT OF LABOR
5092523OtherAETNA PPO
6052423OtherAETNA HMO
166326ZADNMedicare PIN
6052423OtherAETNA HMO