Provider Demographics
NPI:1366402349
Name:DEDINSKY, MARK JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:DEDINSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 740550
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70174
Mailing Address - Country:US
Mailing Address - Phone:504-366-7638
Mailing Address - Fax:504-366-1029
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:TULANE EMERGENCY DEPT
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112
Practice Address - Country:US
Practice Address - Phone:504-988-5711
Practice Address - Fax:504-366-1029
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA021853207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA00657018Medicaid
G01735Medicare UPIN
LA00657018Medicaid