Provider Demographics
NPI:1376193474
Name:MARK A LATINA MD LLC
Entity Type:Organization
Organization Name:MARK A LATINA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LATINA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-942-9876
Mailing Address - Street 1:20 PONDMEADOW DR STE 203
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3261
Mailing Address - Country:US
Mailing Address - Phone:781-942-9876
Mailing Address - Fax:781-942-9877
Practice Address - Street 1:20 PONDMEADOW DR STE 203
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3261
Practice Address - Country:US
Practice Address - Phone:781-942-9876
Practice Address - Fax:781-942-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty