Provider Demographics
NPI:1427065879
Name:CARNEY, MARK DIXON (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DIXON
Last Name:CARNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:DIXON
Other - Last Name:CARNEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:250 PLEASANT ST
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-7559
Mailing Address - Country:US
Mailing Address - Phone:603-227-7000
Mailing Address - Fax:603-228-3307
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7559
Practice Address - Country:US
Practice Address - Phone:603-228-7200
Practice Address - Fax:603-227-7562
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8793208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005388Medicaid
B35939Medicare UPIN
NHRE243101Medicare UPIN