Provider Demographics
NPI:1316931421
Name:PEELER, MARK O'BRIEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:O'BRIEN
Last Name:PEELER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 64323
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4323
Mailing Address - Country:US
Mailing Address - Phone:443-481-6566
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2002 MEDICAL PKWY
Practice Address - Street 2:SUITE 520
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3046
Practice Address - Country:US
Practice Address - Phone:410-266-1188
Practice Address - Fax:410-266-9466
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-02
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056208208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
60854002OtherBCBS
7413170OtherAETNA PPO
MD243601900Medicaid
3330967OtherAETNA HMO
383406OtherMAMSI
J2120001OtherBCBS
201244000OtherFEDERAL WORKMANS COMP
60854004OtherBCBS
6645368OtherCIGNA
7413170OtherAETNA PPO
383406OtherMAMSI
60854002OtherBCBS
P00061988Medicare PIN