Basic Information
| Provider Information | |||||||||
| NPI: | 1548214372 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEBLOIS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | EDWIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1115 BOULDERS PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8045605595 | ||||||||
| FaxNumber: | 8045609029 | ||||||||
| Practice Location | |||||||||
| Address1: | 1115 BOULDERS PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | NORTH CHESTERFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232254067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043201339 | ||||||||
| FaxNumber: | 8043305829 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 01/28/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0114X | 101036512 | VA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 0101036512 | VA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 061547 | 01 | VA | ANTHEM HEALTHKEEPERS PLUS | OTHER | 061547 | 01 | VA | ANTHEM | OTHER | 540885859 | 01 | VA | C&O EMPLOYEES HOSP ASSO | OTHER | 540885859 | 01 | VA | FARA | OTHER | 006440193 | 05 | VA | MEDICAID | 2138265 | 01 | VA | UNITED HEALTH CARE MAMSI | OTHER | 540885859 | 01 | VA | FOCUS | OTHER | 540885859 | 01 | VA | MULTIPLAN | OTHER | 540885859 | 01 | VA | CENVANET | OTHER | 1548214372 | 05 | VA | MEDICAID | 536767 | 01 | VA | AETNA/US HMO | OTHER | 540885859 | 01 | VA | PHCS | OTHER | 540885859 | 01 | VA | CIGNA | OTHER | 540885859 | 01 | VA | COMPMANAGEMENT | OTHER | 200019198 | 01 | VA | RR MEDICARE | OTHER | 48192 | 01 | VA | OPTIMA HEALTH | OTHER | 540885859 | 01 | VA | CORVEL | OTHER | 540885859 | 01 | VA | FIRST HEALTH/CCN | OTHER |