Provider Demographics
NPI:1801886346
Name:LATINA, MARK ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTHONY
Last Name:LATINA
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 1:20 PONDMEADOW DR STE 203
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:MA
Mailing Address - Zip Code:01867-3261
Mailing Address - Country:US
Mailing Address - Phone:781-942-9876
Mailing Address - Fax:781-942-9877
Practice Address - Street 1:20 PONDMEADOW DR STE 203
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3261
Practice Address - Country:US
Practice Address - Phone:781-942-9876
Practice Address - Fax:781-942-9877
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48630207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA048630OtherTUFTS HEALTH PLAN
MAJ04369OtherBCBS MA
MA3013341Medicaid
A66345Medicare UPIN
MA048630OtherTUFTS HEALTH PLAN