Healthcare Provider Details

I. General information

NPI: 1821082892
Provider Name (Legal Business Name): MICHAEL H MARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28467 DUPONT BLVD
MILLSBORO DE
19966-3749
US

IV. Provider business mailing address

28467 DUPONT BLVD
MILLSBORO DE
19966-3749
US

V. Phone/Fax

Practice location:
  • Phone: 302-933-0111
  • Fax: 302-933-0990
Mailing address:
  • Phone: 302-933-0111
  • Fax: 302-933-0990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberC1-0003541
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: