Provider Demographics
NPI:1891760005
Name:EPSTEIN, MARK PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:PHILIP
Last Name:EPSTEIN
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 1:131 ORNAC
Mailing Address - Street 2:JOHN CUMING BUILDING SUITE 560
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742
Mailing Address - Country:US
Mailing Address - Phone:978-371-1551
Mailing Address - Fax:978-371-1518
Practice Address - Street 1:131 ORNAC
Practice Address - Street 2:JOHN CUMING BUILDING SUITE 560
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742
Practice Address - Country:US
Practice Address - Phone:978-371-1551
Practice Address - Fax:978-371-1518
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ23602OtherBLUE CROSS BLUE SHEILD
MA0129640Medicaid
MAAA15373OtherHARVARD PILGRIM HEALTHCAR
MAA32533Medicare ID - Type Unspecified
MA0129640Medicaid