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NPI Code Detail

MEDICARE: DR. MARK H DEAN D.O.

MEDICARE: DR. MARK H DEAN D.O.
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
1208VP0014XInterventional Pain Medicine PhysicianVA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1177603OTHERVAANTHEM
29831443OTHERVACIGNA

General Provider Information

NPI Number : 1265441083
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK H DEAN D.O.
Provider Business Mailing Address
First Line : 630 PETER JEFFERSON PKWY STE 170
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22911-4624
Country : US
Telephone Number : 434-975-2555
Fax Number : 434-974-6900
Provider Business Practice Location Address
First Line : 630 PETER JEFFERSON PKWY STE 170
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22911-4624
Country : US
Telephone Number : 434-975-2555
Fax Number : 434-974-6900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/08/2006
Last Update Date : 07/08/2007

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