Provider Demographics
NPI:1255307781
Name:HRYNIEWICH, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HRYNIEWICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5 NEPONSET ST
Mailing Address - Street 2:WOT 2ND FL, STE C203
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01606-2714
Mailing Address - Country:US
Mailing Address - Phone:978-466-3212
Mailing Address - Fax:978-534-3581
Practice Address - Street 1:225 NEW LANCASTER RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-4958
Practice Address - Country:US
Practice Address - Phone:978-466-3212
Practice Address - Fax:978-534-3581
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA49755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110064803AMedicaid
29182OtherCHILDRENS MEDICAL SECURIT
AA1227OtherHARVARD PILGRIM HEALTHCAR
J03498OtherBLUE SHIELD HMO BLUE
J03498OtherBLUE SHIELD INDEMNITY
042472266OtherHEALTHCARE VALUE MANAGEME
1150149OtherFIRST HEALTH
9900203OtherFALLON COMMUNITY HEALTH P
042472266OtherONE HEALTH PLAN
5968723OtherUS HEALTHCARE
042472266OtherPRIVATE HEALTHCARE SYSTEM
29182OtherHEALTHY START
J03498OtherBLUE CARE ELECT
5968723OtherAETNA
6180752OtherWELFARE
8739061OtherCIGNA HEALTH PLAN
MA6180752Medicaid
5968723OtherUS HEALTHCARE
MAJ03498Medicare ID - Type Unspecified
042472266OtherONE HEALTH PLAN