Healthcare Provider Details

I. General information

NPI: 1649240011
Provider Name (Legal Business Name): MARK MICHAEL MORTON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WAHOO AVE BLDG 449
GROTON CT
06349-2324
US

IV. Provider business mailing address

PO BOX 900
GROTON CT
06349-5900
US

V. Phone/Fax

Practice location:
  • Phone: 860-694-4873
  • Fax:
Mailing address:
  • Phone: 860-694-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number5101014320
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number5101014320
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number5101014320
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: