Individual
MARK D DEBOER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1204 W MAIN ST, CHARLOTTESVILLE, VA 22903-2824
(434) 924-0123
(434) 243-3300
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
0101232515
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730100868
—
VA
05
—
232445
—
OR
Enumeration date
07/22/2006
Last updated
08/09/2023
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