Provider Demographics
NPI:1184789323
Name:CONSTANTIAN, MARK BARBOUR (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:BARBOUR
Last Name:CONSTANTIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH5913208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHCONH6841Medicare ID - Type UnspecifiedMEDICARE ID #
NHB86132Medicare UPIN