Provider Demographics
NPI:1770502106
Name:DURCAN, MARK M (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:DURCAN
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 1:74 PLEASANT ST
Mailing Address - Street 2:STE 204
Mailing Address - City:NEW LONDON
Mailing Address - State:NH
Mailing Address - Zip Code:03257-5881
Mailing Address - Country:US
Mailing Address - Phone:207-618-9355
Mailing Address - Fax:207-618-9356
Practice Address - Street 1:273 PAYNE RD
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9593
Practice Address - Country:US
Practice Address - Phone:207-618-9355
Practice Address - Fax:207-618-9356
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH9799207P00000X, 207R00000X, 208000000X, 207RA0401X
MEMD20347207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0108262Y0NH03OtherANTHEM
NH30201928Medicaid
69151OtherTUFTS
NHG18766OtherNHBS RAN
MA0188107Medicaid
7067015OtherAETNA
NH7067015OtherAETNA
AA105262OtherHARVARD PILGRIM
P00191358OtherRAILROAD MEDICARE
G18766Medicare UPIN
7067015OtherAETNA
NHUX5293Medicare PIN