Provider Demographics
NPI:1265509889
Name:POZNANSKY, MARK C (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:POZNANSKY
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - Street 2:PO BOX 9142
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-0287
Mailing Address - Fax:617-726-2894
Practice Address - Street 1:INFECTIOUS DISEASE ASSOCIATES
Practice Address - Street 2:55 FRUIT STREET COX 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2696
Practice Address - Country:US
Practice Address - Phone:617-726-3906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157686207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ19630OtherBCBS MA
MA3190765Medicaid
MA157686OtherTUFTS HEALTH PLAN
MAA29185Medicare ID - Type Unspecified
MA3190765Medicaid