Healthcare Provider Details

I. General information

NPI: 1265440408
Provider Name (Legal Business Name): MARK L. PLASTER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 05/02/2023
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39371 HARPERS CORNER RD
MECHANICSVILLE MD
20659-6218
US

IV. Provider business mailing address

4794 BAYFIELDS RD
HARWOOD MD
20776-9575
US

V. Phone/Fax

Practice location:
  • Phone: 302-545-0406
  • Fax:
Mailing address:
  • Phone: 302-545-0406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD0056308
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberD0056308
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: