1992765036 NPI number — MARK PORWAY MD

Table of content: MARK PORWAY MD (NPI 1992765036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992765036 NPI number — MARK PORWAY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PORWAY
Provider First Name:
MARK
Provider Middle Name:
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:
1992765036
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 ATWOOD DR
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01060-4272
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-570-4900
Provider Business Mailing Address Fax Number:
413-570-4196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 ATWOOD DR
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-4272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-570-4900
Provider Business Practice Location Address Fax Number:
413-570-4196
Provider Enumeration Date:
03/24/2006

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: 207RC0000X , with the licence number:  58063 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04-3476949 . This is a "UNICARE/GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3476949 . This is a "CONSOLIDATED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3476949 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3476949 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3476949 . This is a "PLAN VISTA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 110044797A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-3476949 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J06661 . This is a "BCBSMA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3476949 . This is a "NORTHEAST HEALTHCARE ALLI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 15514 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3025365 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-3476949 . This is a "PHCS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 058063 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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