Provider Demographics
NPI:1265441083
Name:DEAN, MARK H (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:DEAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:630 PETER JEFFERSON PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-4624
Mailing Address - Country:US
Mailing Address - Phone:434-975-2555
Mailing Address - Fax:434-974-6900
Practice Address - Street 1:630 PETER JEFFERSON PKWY STE 170
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4624
Practice Address - Country:US
Practice Address - Phone:434-975-2555
Practice Address - Fax:434-974-6900
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA177603OtherANTHEM
VA9831443OtherCIGNA
VA9831443OtherCIGNA