Healthcare Provider Details

I. General information

NPI: 1487670634
Provider Name (Legal Business Name): MARK LOREN DENZINE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE # A41
CLEVELAND OH
44195
US

IV. Provider business mailing address

2000 MEDICAL PKWY STE 101
ANNAPOLIS MD
21401-3743
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-3927
  • Fax:
Mailing address:
  • Phone: 410-268-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberH84961
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34.012790
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOT014667
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: