1508840612 NPI number — MARK S SISKIND MD

Table of content: MARK S SISKIND MD (NPI 1508840612)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508840612 NPI number — MARK S SISKIND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SISKIND
Provider First Name:
MARK
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508840612
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 WATERMAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-438-5950
Provider Business Mailing Address Fax Number:
401-435-2561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
277 PLEASANT ST
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02721-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-438-5950
Provider Business Practice Location Address Fax Number:
401-435-2561
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RN0300X , with the licence number:  53848 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: 8373 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8373 . This is a "BLUE CROSS" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 10137MIR . This is a "HARVARD PILGRIM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000033673 . This is a "BOSTON MEDICAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 39004908 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1488 . This is a "NEIGHBORHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 782413 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: J30013 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6198023 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008373 . This is a "TUFTS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0702100003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3100129 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7003280 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004616 . This is a "BLUE CHIP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 3110893 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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