Provider Demographics
NPI:1649249418
Name:ARTUSIO, MARK E (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:ARTUSIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:45 THOMAS JOHNSON DRIVE
Mailing Address - Street 2:SUITE 211
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702
Mailing Address - Country:US
Mailing Address - Phone:301-694-3200
Mailing Address - Fax:301-662-5288
Practice Address - Street 1:45 THOMAS JOHNSON DRIVE
Practice Address - Street 2:SUITE 211
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702
Practice Address - Country:US
Practice Address - Phone:301-694-3200
Practice Address - Fax:301-662-5288
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2020-04-28
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Provider Licenses
StateLicense IDTaxonomies
MDD0031041208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD295711600Medicaid
MD177L-091BMedicare ID - Type UnspecifiedTRAILBLAZER HEALTH
E14033Medicare UPIN