Provider Demographics
NPI:1861695181
Name:EID, MARK P (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:P
Last Name:EID
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:820 SPRINGER DR
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6413
Mailing Address - Country:US
Mailing Address - Phone:815-744-8554
Mailing Address - Fax:
Practice Address - Street 1:1985 JEFFERSON DAVIS HWY
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-5298
Practice Address - Country:US
Practice Address - Phone:540-373-6647
Practice Address - Fax:540-479-1656
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2022-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101249163207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV2650A178Medicare PIN