Provider Demographics
NPI:1023167673
Name:KUSHNER, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:KUSHNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:110 HOSPITAL RD STE 310
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4041
Mailing Address - Country:US
Mailing Address - Phone:410-535-2005
Mailing Address - Fax:410-535-4850
Practice Address - Street 1:110 HOSPITAL RD STE 310
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4041
Practice Address - Country:US
Practice Address - Phone:410-535-2005
Practice Address - Fax:410-535-4850
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD23468207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32905001OtherCAREFIRST OF MARYLAND
MD336799OtherMAMSI HMO
MD2154481OtherAETNA HMO SPECIALIST
MD7720001OtherAETNA NON-HMO SPECIALIST
DCC0410006OtherCAREFIRST OF DC
MDD74689Medicare UPIN
MD7720001OtherAETNA NON-HMO SPECIALIST