Provider Demographics
NPI:1548243587
Name:BRIGHT, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:BRIGHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name Type:
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Mailing Address - Street 1:200 COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1225
Mailing Address - Country:US
Mailing Address - Phone:508-339-4144
Mailing Address - Fax:508-261-9940
Practice Address - Street 1:200 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1225
Practice Address - Country:US
Practice Address - Phone:508-339-4144
Practice Address - Fax:508-261-9940
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54645207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6194389Medicaid
MAAA206543OtherHPHC
MA54645OtherTUFTS
MAAA206543OtherHPHC
A58052Medicare UPIN