Provider Demographics
NPI:1699702290
Name:RAIZIN, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:RAIZIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2 ESSEX CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-2926
Mailing Address - Country:US
Mailing Address - Phone:978-977-4210
Mailing Address - Fax:978-977-4226
Practice Address - Street 1:2 ESSEX CENTER DR
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-2902
Practice Address - Country:US
Practice Address - Phone:978-977-4210
Practice Address - Fax:978-977-4226
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2021-03-07
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Provider Licenses
StateLicense IDTaxonomies
MA222864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2086701Medicaid
MA413329OtherTUFTS
MAJ28142OtherBLUE CROSS
MA0033863OtherNEIGHBORHOOD HEALTH
MAAA19094OtherHARVARD PILGRIM
MAA37856Medicare PIN
MA0033863OtherNEIGHBORHOOD HEALTH