Provider Demographics
NPI:1902812316
Name:DEAN, MARK T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1076 RIBAUT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5476
Mailing Address - Country:US
Mailing Address - Phone:843-525-0045
Mailing Address - Fax:843-525-0826
Practice Address - Street 1:1076 RIBAUT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5476
Practice Address - Country:US
Practice Address - Phone:843-525-0045
Practice Address - Fax:843-525-0826
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC18108207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC181083Medicaid
F81641Medicare UPIN
F816417615Medicare PIN