Provider Demographics
NPI:1538285341
Name:WARSHAUER, MARK EDWARD
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:WARSHAUER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 MARLBOROUGH ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-1725
Mailing Address - Country:US
Mailing Address - Phone:617-437-1520
Mailing Address - Fax:617-236-1478
Practice Address - Street 1:341 MARLBOROUGH ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-1725
Practice Address - Country:US
Practice Address - Phone:617-437-1520
Practice Address - Fax:617-236-1478
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA132911223G0001X
MA192361223P0300X
MA210761223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0300XDental ProvidersDentistPeriodontics
Not Answered1223P0700XDental ProvidersDentistProsthodontics