Provider Demographics
NPI:1508840612
Name:SISKIND, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:SISKIND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:318 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914
Mailing Address - Country:US
Mailing Address - Phone:401-438-5950
Mailing Address - Fax:401-435-2561
Practice Address - Street 1:277 PLEASANT ST
Practice Address - Street 2:STE 305
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-3005
Practice Address - Country:US
Practice Address - Phone:401-438-5950
Practice Address - Fax:401-435-2561
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA53848207RN0300X
RI8373207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI8373OtherBLUE CROSS
10137MIROtherHARVARD PILGRIM
MA000000033673OtherBOSTON MEDICAL
39004908OtherRAILROAD MEDICARE
1488OtherNEIGHBORHOOD
782413OtherAETNA
MAJ30013OtherBLUE CROSS
MA6198023Medicaid
008373OtherTUFTS
0702100003OtherCIGNA
3100129OtherUNITED
RI7003280Medicaid
RI004616OtherBLUE CHIP
MA3110893Medicaid
10137MIROtherHARVARD PILGRIM
MAJ30013Medicare PIN