Provider Demographics
NPI:1679618763
Name:OKUSA, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:OKUSA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:500 RAY C HUNT DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-2981
Mailing Address - Country:US
Mailing Address - Phone:434-980-6140
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:THE KIDNEY CENTER UVA HOSPITAL W
Practice Address - Street 2:HOSPITAL DRIVE, 5TH FLOOR
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22908-0001
Practice Address - Country:US
Practice Address - Phone:434-924-1894
Practice Address - Fax:434-924-5848
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101035775207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAE74576Medicare UPIN