Provider Demographics
NPI:1205892924
Name:TROTT, MARK A (PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TROTT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-5813
Mailing Address - Country:US
Mailing Address - Phone:508-226-3544
Mailing Address - Fax:
Practice Address - Street 1:845 N MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-5700
Practice Address - Country:US
Practice Address - Phone:401-521-7300
Practice Address - Fax:401-521-7307
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1279363A00000X, 363AM0700X
RIPA00053363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIPA00053OtherUHP RI
RI0000023500OtherBCBS OF RI
RI0000023500OtherBCBS OF RI
MAAP1505Medicare ID - Type Unspecified