Provider Demographics
NPI:1356323604
Name:KRIVOPAL, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KRIVOPAL
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 1:400 HUNNEWELL ST STE 5
Mailing Address - Street 2:BID HEALTHCARE HOSPITALIST SERVICES
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02494-1300
Mailing Address - Country:US
Mailing Address - Phone:617-754-0744
Mailing Address - Fax:617-754-0739
Practice Address - Street 1:400 HUNNEWELL ST STE 5
Practice Address - Street 2:BID HEALTHCARE HOSPITALIST SERVICES
Practice Address - City:NEEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02494-1300
Practice Address - Country:US
Practice Address - Phone:617-754-0744
Practice Address - Fax:617-754-0739
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204774207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA117650OtherMASSHEALTH
MA117650OtherMASSHEALTH