Provider Demographics
NPI:1225005465
Name:ABENSOHN, MARK HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HOWARD
Last Name:ABENSOHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:266 MAIN ST
Mailing Address - Street 2:P.O. BOX 469
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-2018
Mailing Address - Country:US
Mailing Address - Phone:508-359-8141
Mailing Address - Fax:508-359-8005
Practice Address - Street 1:266 MAIN ST
Practice Address - Street 2:UNIT 4
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-2018
Practice Address - Country:US
Practice Address - Phone:508-359-8141
Practice Address - Fax:508-359-8005
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA56322207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2089726Medicaid
MAJ01109Medicare ID - Type Unspecified
MAA56197Medicare UPIN