Active NPI
Michael H Mark, MD
- Neurology Physician
- Millsboro, DE
National Provider Identifier
1821082892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- C1-0003541
- Practice address
- 28467 Dupont Blvd
Millsboro, DE 19966-3749 - Phone
- (302) 933-0111
- Fax
- (302) 933-0990
- NPI assigned
- Sep 7, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | C1-0003541 | DE | Primary |
Addresses
Primary practice location
28467 Dupont Blvd
Millsboro, DE 19966-3749
Mailing address
28467 Dupont Blvd
Millsboro, DE 19966-3749
Phone (302) 933-0111
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 51038312C | Other | BLUE SHIELD DE | |
| 265039 | Other | MAMSI | |
| 4275007 | Other | AETNA | |
| D000288 | Other | TRICARE | |
| KG82 | Other | MD BLUE SHIELD | |
| C08438 | Other | MID ATLANTIC | |
| 0000245501 | Medicaid | DE | |
| 130018400 | Other | RAILROAD MEDICARE | |
| G2420004 | Other | DELMARVA HEALTH PLAN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126051200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1365465600000",
"number": "1821082892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28467 DUPONT BLVD",
"city": "MILLSBORO",
"state": "DE",
"postal_code": "199663749",
"telephone_number": "302-933-0111",
"fax_number": "302-933-0990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28467 DUPONT BLVD",
"city": "MILLSBORO",
"state": "DE",
"postal_code": "199663749",
"telephone_number": "302-933-0111",
"fax_number": "302-933-0990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARK",
"first_name": "MICHAEL",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-07",
"last_updated": "2013-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "DE",
"license": "C1-0003541",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD DE",
"identifier": "51038312C",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAMSI",
"identifier": "265039",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4275007",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "D000288",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MD BLUE SHIELD",
"identifier": "KG82",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MID ATLANTIC",
"identifier": "C08438",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0000245501",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "130018400",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELMARVA HEALTH PLAN",
"identifier": "G2420004",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Millsboro, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.