Provider Demographics
NPI:1619955465
Name:EUBANKS, MARK J (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10 CORDAGE PARK CIR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7318
Mailing Address - Country:US
Mailing Address - Phone:508-747-2924
Mailing Address - Fax:508-830-0854
Practice Address - Street 1:10 CORDAGE PARK CIR
Practice Address - Street 2:SUITE 201
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7318
Practice Address - Country:US
Practice Address - Phone:508-747-2924
Practice Address - Fax:508-830-0854
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2015-01-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA224065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA462282OtherTUFTS HEALTH PLAN
MAAA42003OtherHARVARD PILGRIM
MAJ29252OtherBCBSMA
MA2108488Medicaid
MA2108488Medicaid
MAAA42003OtherHARVARD PILGRIM
MAI39669Medicare UPIN