Individual
MARK B. GLOUDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
541 SUNSET LN, SUITE 103, CULPEPER, VA 22701-3979
(540) 825-4440
(540) 825-4026
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101043825
VA
208600000X
Surgery Physician
Primary
0101043825
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010192471
—
VA
Enumeration date
07/12/2006
Last updated
10/09/2020
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