Provider Demographics
NPI:1437183266
Name:MARK, JENNIFER S (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:S
Last Name:MARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 WARD AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2863
Mailing Address - Country:US
Mailing Address - Phone:978-249-3511
Mailing Address - Fax:
Practice Address - Street 1:ATHOL MEMORIAL HOSPITAL
Practice Address - Street 2:2033 MAIN STREET
Practice Address - City:ATHOL
Practice Address - State:MA
Practice Address - Zip Code:01331
Practice Address - Country:US
Practice Address - Phone:978-249-3511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA203960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine