MARK WADE DICKINSON (NPI# 1154320059) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154320059 |
Entity Type | Individual |
Full Name | MARK WADE DICKINSON |
Credential | MD |
Practice Address |
388 Commonwealth Ave Mgh Back Bay Boston MA 02215-2800 |
Practice Telephone | 6172677171 |
Practice Fax Number | 6172622608 |
Mailing Telephone | 6172677171 |
Mailing Fax Number | 6172622608 |
Enumeration Date | 2005-07-21 |
Last Update Date | 2009-08-12 |
Gender Code | M |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 207R00000X | Internal Medicine | 230380 | MA | Allopathic & Osteopathic Physicians |
Y | 208000000X | Pediatrics | 230380 | MA | Allopathic & Osteopathic Physicians |
N | 208M00000X | Hospitalist | 230380 | MA | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
MA | HPHC | AA77715 | 01 |
MA | FALLON | 121680 | 01 |
MA | MEDICARE PTAN GROUP 21241 | OX2507 | 01 |
MA | BCBS | J41145 | 01 |
MA | MEDICARE PTAN GROUP 21240 | OX2506 | 01 |
MA | 2128071 | 05 | |
MA | TUFTS | 495561 | 01 |
MA | NETWORK HEALTH | 96009801 | 01 |
MA | MASSHEALTH | AA77715 | 01 |
MA | CIGNA | 3975642 | 01 |
MA | AETNA | 5035676 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1457430464 | Mark S Dickinson | Optometrist | 13190 Owens Way, Alpharetta, GA 30004-7357 | 2006-11-02 |
1124066055 | Mark David Dickinson | Dentist | 4 Scott Dyer Rd, Cape Elizabeth, ME 04107-2017 | 2006-06-03 |
1215914239 | Mark Thomas Dickinson | Urology | 11370 Anderson Street, Suite 1100, Loma Linda, CA 92354 | 2005-12-30 |
Street Address |
388 COMMONWEALTH AVE MGH BACK BAY |
City | BOSTON |
State | MA |
Zip Code | 02215-2800 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1982135257 | Leah Wilson | Nurse Practitioner | 388 Commonwealth Ave, Boston, MA 02215-2800 | 2017-03-27 |
1376900050 | Amir Mohsen Mahoozi Dmd, PC | Health Maintenance Organization | 388 Commonwealth Ave, Unit B-1, Boston, MA 02215-2800 | 2016-01-26 |
1679851695 | Pooja K Khialani | Student in an Organized Health Care Education/Training Program | 388 Commonwealth Ave, Lower Level, Boston, MA 02215-2800 | 2011-07-25 |
1982892741 | Mark Mizner, Dmd | Dentist | 388 Commonwealth Ave, Boston, MA 02215-2800 | 2007-10-05 |
1548389406 | Joseph James Milavec | Dentist | 388 Commonwealth Ave, Office Suite #l3, Boston, MA 02215-2800 | 2007-03-29 |
1295875268 | Robin R Cox | Dentist | 388 Commonwealth Ave, Unit B3, Boston, MA 02215-2800 | 2007-02-07 |
1184771065 | Susan Hata | Internal Medicine | 388 Commonwealth Ave, Boston, MA 02215-2800 | 2007-01-04 |
1467471946 | Mark Alan Mizner | Dentist | 388 Commonwealth Ave, Boston, MA 02215-2800 | 2006-07-18 |
1235192949 | Edna C.a. Butaney | Family Medicine | 388 Commonwealth Ave, Unit B2, Boston, MA 02215-2800 | 2006-04-11 |
1750359477 | Wei Lien | Internal Medicine | 388 Commonwealth Ave, Mgh Back Bay, Boston, MA 02215-2800 | 2006-03-09 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1336746775 | Lee T Gernon-lakin | Physician Assistant | 202 Robinson Hall, 360 Huntington Ave, Boston, MA 02215 | 2020-10-08 |
1821695933 | Matthew John Needham | Student in an Organized Health Care Education/Training Program | 330 Brookline Ave, Yamins 2nd Floor, Department of Anesthesia, Boston, MA 02215 | 2020-10-02 |
1114533866 | Cdg Back Bay LLC | Clinic/Center | 400 Commonwealth Ave 3rd Floor, Boston, MA 02215 | 2020-09-18 |
1619595105 | Natasha Larocque | Radiology | 330 Brookline Avenue, Sherman 231, Beth Israel Deacones, Radiology Education Office, Boston, MA 02215 | 2020-07-10 |
1538783089 | Yutsz Cherng | Counselor | 870r Commonwealth Avenue, Boston, MA 02215 | 2020-06-01 |
1306495924 | Anthony Rosellini | Psychologist | 900 Commonwealth Avenue (east), 2nd Floor, Boston, MA 02215 | 2019-09-06 |
1427605278 | Liana Zucco | Student in an Organized Health Care Education/Training Program | Beth Israel Deaconess Medical Centre, Dept Anesthesia, 330 Brookline Ave, Ya-02q02, Boston, MA 02215 | 2019-08-26 |
1831759430 | Brian William Hayes | Radiology | 330 Brookline Avenue, Beth Israel Deaconess Medical Cen, Boston, MA 02215 | 2019-06-17 |
1396304358 | Elizabeth Hai Yen Du | Student in an Organized Health Care Education/Training Program | Beth Israel Deaconess Medical Center, Department of Rad, 330 Brookline Avenue, Boston, MA 02215 | 2019-06-12 |
1922665439 | Corey Shaphard Miller | Student in an Organized Health Care Education/Training Program | 300 Brookline Avenue, Bidmc, Dana 501, Boston, MA 02215 | 2019-05-21 |
Find all providers in zip 02215 |
Taxonomy Code | 208000000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1639790280 | Allison Seats | Pediatrics | 265 Hyde Park Ave Apt 1rf, Boston, MA 02130-4222 | 2020-05-05 |
1154957132 | Katherine Erin Douglas | Pediatrics | 801 Albany Street, 3rd Floor, Department of Pediatrics, Boston, MA 02119 | 2020-03-21 |
1346871381 | Heather Mccaslin Kempczinski | Pediatrics | 360 Beacon St Apt 1, Boston, MA 02116-1063 | 2020-01-29 |
1083148167 | Daniel Digiacomo | Pediatrics | 55 Fruit St # 165, Boston, MA 02114-2621 | 2017-04-17 |
1568814283 | Jessica Leigh Dicarlo | Pediatrics | 800 Tufts Medical Center, Box 286, Department of Pediatrics, Boston, MA 02111-1651 | 2016-07-06 |
1336598598 | Nicole Savina Rittershaus | Pediatrics | 354 Tremont Street, Boston, MA 02116 | 2016-06-08 |
1255793493 | Kelsey A. Egan | Pediatrics | 840 Harrison Ave # Menino4, Boston, MA 02118-2905 | 2016-03-27 |
1851787626 | Tierney Mancuso Morrison | Pediatrics | 300 Longwood Ave # 961, Boston, MA 02115-5724 | 2015-04-08 |
1710379797 | Marleny Yordania Aquino Cabrera | Pediatrics | 725 Albany St Ste 8c, Boston, MA 02118-2526 | 2015-02-27 |
1558762203 | Desiree Sierra Velez | Pediatrics | 32 Fruit St Fl 6, Boston, MA 02114-2620 | 2014-09-12 |
Find all providers in BOSTON |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.