Provider Demographics
NPI:1316332430
Name:REAL, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:REAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:DEPT OF MEDICINE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-8541
Mailing Address - Fax:877-303-1460
Practice Address - Street 1:7501 SURRATTS RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3362
Practice Address - Country:US
Practice Address - Phone:301-877-4599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD93538207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology