MEDICARE: MARK JOHN BASKERVILLE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	D54897	MD
2	207L00000X	Anesthesiology Physician	MD23614	OR
3	207P00000X	Emergency Medicine Physician	D0054897	MD

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50086273	OTHER	OR	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	A048	OTHER	OR	TRICARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306801824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOHN BASKERVILLE M.D.

Provider Business Mailing Address
First Line	:	6201 GREENLEIGH AVE
Second Line	:
City	:	MIDDLE RIVER
State	:	MD
Zip	:	21220-2004
Country	:	US
Telephone Number	:	410-933-0000
Fax Number	:	410-500-4266

Provider Business Practice Location Address
First Line	:	5755 CEDAR LN
Second Line	:
City	:	COLUMBIA
State	:	MD
Zip	:	21044-2912
Country	:	US
Telephone Number	:	410-884-8688
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	03/09/2026

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Directions to “ MARK JOHN BASKERVILLE M.D.” Practice Location

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