Individual
MARK R. VESELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
22 S GREENE ST, BALTIMORE, MD 21201-1544
(410) 328-5793
(410) 328-0248
Mailing address
PO BOX 64442, BALTIMORE, MD 21264-4442
(410) 328-5793
(410) 328-0248
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
D67290
MD
207RI0011X
Interventional Cardiology Physician
Primary
D67290
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
414670100
—
MD
01
—
932536-01
CAREFIRST BC/BS
MD
01
—
S062-0331
CAREFIRST BC/BS REGIONAL
MD
Enumeration date
02/10/2007
Last updated
04/09/2015
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