Provider Demographics
NPI:1609863729
Name:HILTY, MARK R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:HILTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:200 MILL RD
Mailing Address - Street 2:STE 180
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:363 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-3703
Practice Address - Country:US
Practice Address - Phone:508-973-7447
Practice Address - Fax:508-973-7424
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2020-04-29
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Provider Licenses
StateLicense IDTaxonomies
MA81533207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIMH13050Medicaid
MA110056214AMedicaid
MAMX8514Medicare PIN