Healthcare Provider Details

I. General information

NPI: 1124091806
Provider Name (Legal Business Name): MARK S VOLK MD, DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LONGWOOD AVE FLOOR 3
BOSTON MA
02115-5711
US

IV. Provider business mailing address

26 HAMMOND CIR
SUDBURY MA
01776-2764
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-4556
  • Fax: 617-730-0337
Mailing address:
  • Phone: 978-443-1992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number79400
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: