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Individual

MARK H MIROCHNICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
840 HARRISON AVE, MENINO 3, BOSTON, MA 02118-2905
(617) 414-5471
(617) 414-4358
Mailing address
720 HARRISON AVE, DOB 503, BOSTON, MA 02118-2371

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
51072
MA
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
51072
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
110042959A
MA
Enumeration date
11/21/2005
Last updated
07/17/2014
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