Dickinson, Mark Wade
Dickinson, Mark Wade is an individual health care provider with primary practice located at 388 Commonwealth Ave Mgh Back Bay, Boston MA 02215-2800. He recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Pediatrics is his primary health care specialty. Dickinson, Mark Wade can be contacted via phone (617) 267-7171.Contact Information
Primary practice address
388 Commonwealth Ave Mgh Back Bay
Boston MA 02215-2800
Phone: (617) 267-7171
Fax: (617) 262-2608
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 230380 | Massachusetts |
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 230380 | Massachusetts |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 230380 | Massachusetts |
Profile Details
| NPI number | 1154320059 |
|---|---|
| LBN Legal business name | Dickinson, Mark Wade |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 21st, 2005 |
| Last updated | Aug 12th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154320059 | NPPES |
| Massachusetts | Other | AA77715 | HPHC |
| Massachusetts | Other | AA77715 | HPHC |
| Massachusetts | Other | 121680 | HPHC |
| Massachusetts | MEDICAID | 2128071 | HPHC |
| Massachusetts | Other | OX2506 | HPHC |
| Massachusetts | Other | 3975642 | HPHC |
| Massachusetts | Other | 495561 | HPHC |
| Massachusetts | Other | 5035676 | HPHC |
| Massachusetts | Other | 96009801 | HPHC |
| Massachusetts | Other | J41145 | HPHC |
| Massachusetts | Other | OX2507 | HPHC |
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