Mark Wade Dickinson

MD | Pediatrics | Male

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Complete Profile:

Mark Wade Dickinson basic information including his official name, gender, specialization, credentials etc. are as mentioned below.

Specialization :	Pediatrics
Provider Name :	Mark Wade Dickinson
Credential :	MD
Gender :	Male

Business Address:

Mark Wade Dickinson address, contact phone number and fax are as below. Patients can directly walkin to the clinic or can call on the below given phone number for appointment.

Primary Address :	388 Commonwealth Ave, Mgh Back Bay Boston, MA, 02215-2800 United States
Phone Number :	617-267-7171
Fax Number :	617-262-2608

Professional Identification Codes:

NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). NPI details are as mentioned below.

NPI Number :	1154320059
NPI Entity Type :	Individual
First Enrolment Date :	21 Jul, 2005
Last Updated On :	12 Aug, 2009

Medicare Participation:

Mark Wade Dickinson participates in medicare and accepts medicare insurance either directly or through association with group practice or medical facility.

Medicare PECOS ID :	3678542271
Medicare Enrollment ID :	I20070406000229
Primary Specialty :	Internal Medicine
Medical School :	University Of California, San Diego School Of Medicine
Graduation Year :	1989
Accepts Medicare?	Yes. Mark Wade Dickinson accepts medicare insurance.

Group Practice Association:

Mark Wade Dickinson is associated with following Group Practice Organizations. Group practices are practice of medicine by a group of physicians who share their premises and other resources. Following list states all the group name with which Mark Wade Dickinson is associated with along with the number of members in that group. He may also accept medicare indirectly via these group practices.

Organisation Name :	Group Practice ID	No. of Members	Practice Address	Group Accepts Medicare
Massachusetts General Physicians Organization Inc	2466365820	2938	55 Fruit St Boston, MA - 021142696 Ph: 6177240287	Yes
The General Hospital Corporation	6507803806	1008	55 Fruit St Boston, MA - 021142621 Ph: 6177262000	Yes

Licenses and Specialities:

Physicians/Organizations can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mark Wade Dickinson are as mentioned. Primary taxonomy code for Mark Wade Dickinson, MD is 208000000X (Pediatrics).

Taxonomy Code	Speciality	Primary	License No.	State
208M00000X	Hospitalist	No	230380	MA
207R00000X	Internal Medicine	No	230380	MA
208000000X	Pediatrics	Yes	230380	MA

Legacy Identifiers:

Other legacy medical identifiers of Mark Wade Dickinson such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned below.

Identifier	Identifier Type	State	Issuer
495561	Other	MA	TUFTS
OX2506	Other	MA	MEDICARE PTAN GROUP 21240
AA77715	Other	MA	MASSHEALTH
3975642	Other	MA	CIGNA
2128071	MEDICAID	MA
121680	Other	MA	FALLON
5035676	Other	MA	AETNA
96009801	Other	MA	NETWORK HEALTH
OX2507	Other	MA	MEDICARE PTAN GROUP 21241
J41145	Other	MA	BCBS
AA77715	Other	MA	HPHC

Mailing Address:

Mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned business address only.

Mailing Address :	388 Commonwealth Ave, Mgh Back Bay Boston, MA, 02215-2800 United States
Phone Number :	617-267-7171
Fax Number :	617-262-2608

Business Location:

Patients can refer following map for directions to Mark Wade Dickinson practice address. Don't forget to take prior appointment before visiting.
** Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES.