Provider Demographics
NPI:1194726471
Name:MESSENGER, MARK J (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:MESSENGER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:75 SYLVAN ST STE B102
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2764
Mailing Address - Country:US
Mailing Address - Phone:978-774-7566
Mailing Address - Fax:978-223-9953
Practice Address - Street 1:75 SYLVAN ST STE B102
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2764
Practice Address - Country:US
Practice Address - Phone:978-774-7566
Practice Address - Fax:978-223-9953
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-01-30
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Provider Licenses
StateLicense IDTaxonomies
MA59153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3030270Medicaid
MA3030270Medicaid
MAA62762Medicare UPIN