Provider Demographics
NPI:1932498243
Name:MARK B CONSTANTIAN MD PA
Entity Type:Organization
Organization Name:MARK B CONSTANTIAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:BARBOUR
Authorized Official - Last Name:CONSTANTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-880-7700
Mailing Address - Street 1:19 TYLER ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2951
Mailing Address - Country:US
Mailing Address - Phone:603-880-7700
Mailing Address - Fax:603-880-6660
Practice Address - Street 1:19 TYLER ST
Practice Address - Street 2:SUITE 302
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2951
Practice Address - Country:US
Practice Address - Phone:603-880-7700
Practice Address - Fax:603-880-6660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-07
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5913208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHNH6841Medicare PIN