Provider Demographics
NPI:1790546752
Name:SIGWART, MARK THOMAS JR (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:SIGWART
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 GIFFORD ST
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-5119
Mailing Address - Country:US
Mailing Address - Phone:508-457-4900
Mailing Address - Fax:
Practice Address - Street 1:360 GIFFORD ST
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-5119
Practice Address - Country:US
Practice Address - Phone:508-457-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA100368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant