Provider Demographics
NPI:1952532855
Name:MARK W. PRESLAN, M.D., LLC
Entity type:Organization
Organization Name:MARK W. PRESLAN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PRESLAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-572-0655
Mailing Address - Street 1:7671 QUARTERFIELD RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4998
Mailing Address - Country:US
Mailing Address - Phone:443-572-0655
Mailing Address - Fax:443-572-0658
Practice Address - Street 1:7671 QUARTERFIELD RD
Practice Address - Street 2:SUITE 304
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4998
Practice Address - Country:US
Practice Address - Phone:443-572-0655
Practice Address - Fax:443-572-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-27
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0033771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD428711800Medicaid
MD161991Medicare PIN
MDE22992Medicare UPIN