Provider Demographics
NPI:1962409656
Name:MATSUNAGA, MARK THOMAS (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:MATSUNAGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10710 CHARTER DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3128
Mailing Address - Country:US
Mailing Address - Phone:410-997-7246
Mailing Address - Fax:410-997-7226
Practice Address - Street 1:10710 CHARTER DR
Practice Address - Street 2:SUITE 240
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3128
Practice Address - Country:US
Practice Address - Phone:410-997-7246
Practice Address - Fax:410-997-7226
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2011-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0037907207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD304411400Medicaid
MDF01017Medicare UPIN
MD304411400Medicaid