Provider Demographics
NPI:1881689487
Name:RIEUMONT, MARK J (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:RIEUMONT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2330 UTAH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-4817
Mailing Address - Country:US
Mailing Address - Phone:424-290-8004
Mailing Address - Fax:813-253-2299
Practice Address - Street 1:1 TAMPA GENERAL CIRCLE
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606
Practice Address - Country:US
Practice Address - Phone:813-253-2721
Practice Address - Fax:813-977-3720
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA753632085R0202X, 2085R0204X
FLME745912085R0204X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA25160OtherHEALTHY START
NH30203121OtherNH MEDICAID
MA3138402Medicaid
MA4059948OtherCIGNA
MA998109OtherNETWORK
MA300095289OtherRAILROAD MEDICARE
MA2042658OtherFIRST HEALTH & CCN
MA3281OtherFALLON
MA241009OtherHARVARD PILGRIM HEALTHCAR
MA750289OtherTUFTS HEALTH PLAN
MAJ31215OtherBLUE CROSS/BLUE SHIELD
NH01Y002005MA01OtherNH BLUE SHIELD
MA2892557OtherAETNA/US HEALTHCARE
NH01Y002005MA01OtherNH BLUE SHIELD
MA3138402Medicaid