Individual
DR. MARK EDWIN DEBLOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1115 BOULDERS PKWY, SUITE 100, NORTH CHESTERFIELD, VA 23225-4067
(804) 320-1339
(804) 330-5829
Mailing address
1115 BOULDERS PKWY, SUITE 200, NORTH CHESTERFIELD, VA 23225-4067
(804) 560-5595
(804) 560-9029
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
0101036512
VA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
101036512
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006440193
—
VA
01
—
061547
ANTHEM HEALTHKEEPERS PLUS
VA
05
—
1548214372
—
VA
01
—
200019198
RR MEDICARE
VA
01
—
2138265
UNITED HEALTH CARE MAMSI
VA
01
—
48192
OPTIMA HEALTH
VA
01
—
536767
AETNA/US HMO
VA
01
—
540885859
C&O EMPLOYEES HOSP ASSO
VA
Enumeration date
05/19/2006
Last updated
01/28/2013
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