Provider Demographics
NPI:1609967710
Name:MCBRIDE, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MCBRIDE
Suffix:
Gender:M
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:PO BOX 1446
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07962-1446
Mailing Address - Country:US
Mailing Address - Phone:201-538-2334
Mailing Address - Fax:201-829-9174
Practice Address - Street 1:160 E HANOVER AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-3150
Practice Address - Country:US
Practice Address - Phone:201-538-2334
Practice Address - Fax:973-829-9174
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04208000174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223014220OtherTAX ID#
NJ1133306Medicaid
NJIS212OtherOXFORD #
NJ0081577000OtherAMERIHEALTH #
NJ0502944OtherAETNA HMO#
NJ4263101OtherAETNA PPO#
NJ0054902OtherGHI PPO#
NJA23649OtherAMERIHEALTH ADM #
NJ0081577000OtherAMERIHEALTH #
NJ4263101OtherAETNA PPO#