Provider Demographics
NPI:1801873427
Name:HAUPTMAN, MARK D (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:HAUPTMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:26522 LA ALAMEDA
Mailing Address - Street 2:SUITE 120
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6330
Mailing Address - Country:US
Mailing Address - Phone:949-282-1671
Mailing Address - Fax:949-367-0518
Practice Address - Street 1:26800 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6384
Practice Address - Country:US
Practice Address - Phone:949-364-6000
Practice Address - Fax:949-364-3213
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2013-01-23
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Provider Licenses
StateLicense IDTaxonomies
CAG55356207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G553560Medicaid
CAGW290ZMedicare PIN
CAWG55356CMedicare PIN
CA00G553560Medicaid