Healthcare Provider Details

I. General information

NPI: 1174518989
Provider Name (Legal Business Name): MARK P TALLMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 11/03/2025
Certification Date: 11/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST FL 2
BRIGHTON MA
02135-2907
US

IV. Provider business mailing address

601 ELMWOOD AVE BOX 679
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 617-789-2344
  • Fax:
Mailing address:
  • Phone: 585-273-3760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number230092
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number191442
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number230092
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number191442
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: