Provider Demographics
NPI:1093865198
Name:MCLAUGHLIN, MARK P (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:P
Last Name:MCLAUGHLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:320 KENNESTONE HOSPITAL BLVD
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1161
Mailing Address - Country:US
Mailing Address - Phone:770-793-7565
Mailing Address - Fax:770-793-7985
Practice Address - Street 1:320 KENNESTONE HOSPITAL BLVD STE LL1
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1166
Practice Address - Country:US
Practice Address - Phone:770-793-7565
Practice Address - Fax:770-793-7985
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA540792085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA390030337AMedicaid
GA92BBFTXMedicare ID - Type Unspecified
F77216Medicare UPIN