Provider Demographics
NPI:1730137019
Name:CASE, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CASE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:124 SLEEPY HOLLOW DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5838
Mailing Address - Country:US
Mailing Address - Phone:302-449-1710
Mailing Address - Fax:302-449-1717
Practice Address - Street 1:124 SLEEPY HOLLOW DR STE 200
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-5838
Practice Address - Country:US
Practice Address - Phone:302-449-1710
Practice Address - Fax:302-449-1717
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0004730207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE00B677C27Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER NUMBE
F95982Medicare UPIN