Basic Information
| Provider Information | |||||||||
| NPI: | 1548245855 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DUMAS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | N | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5801 BREMO ROAD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850620 | ||||||||
| FaxNumber: | 8042850726 | ||||||||
| Practice Location | |||||||||
| Address1: | 5801 BREMO ROAD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 23226 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850620 | ||||||||
| FaxNumber: | 8042850726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2005 | ||||||||
| LastUpdateDate: | 11/05/2015 | ||||||||
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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 | 207R00000X | 30149 | NC | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 0101247752 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 7929371 | 05 | NC | MEDICAID | 110060522 | 01 | RAILROAD MEDICARE | OTHER | 1548245855 | 05 | VA | MEDICAID |