Provider Demographics
NPI:1871675843
Name:PARKER, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:PARKER
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 1:580 COURT STREET THE CHESHIRE MEDICAL CENTER
Mailing Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:580 COURT STREET THE CHESHIRE MEDICAL CENTER
Practice Address - Street 2:EMERGENCY MEDICINE DEPARTMENT
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-354-6600
Practice Address - Fax:603-354-6605
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5968207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH5968OtherSTATE LICENSE
AP8280430OtherDEA CERTIFICATE
NH9659Medicare ID - Type Unspecified
NH5968OtherSTATE LICENSE