Provider Demographics
NPI:1700065315
Name:WILLIAM W. MARK, JR., M.D., P.A.
Entity Type:Organization
Organization Name:WILLIAM W. MARK, JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MARK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:301-777-8383
Mailing Address - Street 1:224 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2827
Mailing Address - Country:US
Mailing Address - Phone:301-777-8383
Mailing Address - Fax:301-777-2780
Practice Address - Street 1:224 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2827
Practice Address - Country:US
Practice Address - Phone:301-777-8383
Practice Address - Fax:301-777-2780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31221174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD75298Medicare UPIN