Provider Demographics
NPI:1861429334
Name:DAMARIO, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:DAMARIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:991 SIBLEY MEMORIAL HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-5113
Mailing Address - Country:US
Mailing Address - Phone:651-379-3110
Mailing Address - Fax:651-379-3111
Practice Address - Street 1:991 SIBLEY MEMORIAL HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5113
Practice Address - Country:US
Practice Address - Phone:651-379-3110
Practice Address - Fax:651-379-3111
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN39010207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1751675OtherARAZ
MNHP36573OtherHEALTHPARTNERS
WI34319900Medicaid
MN07-00036OtherMEDICA PRIMARY
ND10387Medicaid
MN335J6DAOtherBCBS
MN117633OtherUCARE
SD7777470Medicaid
IA0559732Medicaid
MN07-03521OtherMEDICA CHOICE
MN1032946OtherPREFERRED ONE
MT0658191Medicaid
WI34319900Medicaid
MNE51158Medicare UPIN
MT0658191Medicaid