Provider Demographics
NPI:1194884502
Name:REGINATO, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:REGINATO
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:4165 BLACKHAWK PLAZA CIRCLE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-2308
Mailing Address - Country:US
Mailing Address - Phone:925-736-7070
Mailing Address - Fax:925-736-7075
Practice Address - Street 1:4165 BLACKHAWK PLAZA CIRCLE
Practice Address - Street 2:SUITE 100
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-2308
Practice Address - Country:US
Practice Address - Phone:925-736-7070
Practice Address - Fax:925-736-7075
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA78956207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH60752Medicare UPIN
CAZZZ49219ZMedicare ID - Type Unspecified