Provider Demographics
NPI:1992900013
Name:MARK C. NITZBERG, P.C.
Entity type:Organization
Organization Name:MARK C. NITZBERG, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:NITZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-681-1977
Mailing Address - Street 1:380 R MERRIMACK ST.
Mailing Address - Street 2:STE. 2C
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-681-1977
Mailing Address - Fax:978-686-8918
Practice Address - Street 1:380 R MERRIMACK ST.
Practice Address - Street 2:STE. 2C
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-681-1977
Practice Address - Fax:978-686-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74584207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9781480Medicaid
MA9781480Medicaid
MAM21709Medicare ID - Type UnspecifiedGROUP