Provider Demographics
NPI:1710085030
Name:MARK A. PAINTER, MD, PC
Entity Type:Organization
Organization Name:MARK A. PAINTER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAINTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-769-6768
Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:SUITE G-5
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-769-6768
Mailing Address - Fax:781-769-9780
Practice Address - Street 1:95 CHAPEL ST
Practice Address - Street 2:SUITE G-5
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3155
Practice Address - Country:US
Practice Address - Phone:781-769-6768
Practice Address - Fax:781-769-9780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2070693Medicaid
MA65791OtherCIGNA HEALTH PLAN
MA701738OtherTUFTS HEALTH PLAN
MA000000026642OtherBMC HEALTHNET PLAN
MA0524156OtherAETNA HEALTH PLAN
MA29-02008OtherUNITED HEALTH CARE
MAC18111OtherBC/BS
MA6171OtherHARVARD PILGRIM HEALTH CA
MA0004957OtherNEIGHBORHOOD HEALTH
MA30911OtherFALLON HEALTH PLAN
MAC18111Medicare ID - Type Unspecified