Individual
MARK WADE DICKINSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
388 COMMONWEALTH AVE, MGH BACK BAY, BOSTON, MA 02215-2800
(617) 267-7171
(617) 262-2608
Mailing address
388 COMMONWEALTH AVE, MGH BACK BAY, BOSTON, MA 02215-2800
(617) 267-7171
(617) 262-2608
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
230380
MA
208000000X
Pediatrics Physician
Primary
230380
MA
208M00000X
Hospitalist Physician
230380
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
121680
FALLON
MA
05
—
2128071
—
MA
01
—
3975642
CIGNA
MA
01
—
495561
TUFTS
MA
01
—
5035676
AETNA
MA
01
—
96009801
NETWORK HEALTH
MA
01
—
AA77715
HPHC
MA
01
—
J41145
BCBS
MA
01
—
OX2506
MEDICARE PTAN GROUP 21240
MA
01
—
OX2507
MEDICARE PTAN GROUP 21241
MA
Enumeration date
07/21/2005
Last updated
08/12/2009
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