Provider Demographics
NPI:1366502973
Name:MARK, YVONNE (MD, MMS)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:
Last Name:MARK
Suffix:
Gender:F
Credentials:MD, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MESSENGER ST STE 204
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02762-2258
Mailing Address - Country:US
Mailing Address - Phone:508-695-2099
Mailing Address - Fax:508-695-5099
Practice Address - Street 1:60 MESSENGER ST STE 204
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:MA
Practice Address - Zip Code:02762-2258
Practice Address - Country:US
Practice Address - Phone:508-695-2099
Practice Address - Fax:508-695-5099
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA271154207Q00000X
MDD60825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
20V391Medicare ID - Type Unspecified
H23138Medicare UPIN