Healthcare Provider Details
I. General information
NPI: 1508840612
Provider Name (Legal Business Name): MARK S SISKIND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N
II. Dates (important events)
Enumeration Date: 12/01/2005
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
277 PLEASANT ST STE 305
FALL RIVER MA
02721-3005
US
IV. Provider business mailing address
318 WATERMAN AVE
EAST PROVIDENCE RI
02914
US
V. Phone/Fax
- Phone: 401-438-5950
- Fax: 401-435-2561
- Phone: 401-438-5950
- Fax: 401-435-2561
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RN0300X |
| Taxonomy | Nephrology Physician |
| License Number | 53848 |
| License Number State | MA |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RN0300X |
| Taxonomy | Nephrology Physician |
| License Number | 8373 |
| License Number State | RI |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 8373 |
| Identifier Type | OTHER |
| Identifier State | RI |
| Identifier Issuer | BLUE CROSS |
| # 2 | |
| Identifier | 10137MIR |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | HARVARD PILGRIM |
| # 3 | |
| Identifier | 000000033673 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BOSTON MEDICAL |
| # 4 | |
| Identifier | 39004908 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | RAILROAD MEDICARE |
| # 5 | |
| Identifier | 1488 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | NEIGHBORHOOD |
| # 6 | |
| Identifier | 782413 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 7 | |
| Identifier | J30013 |
| Identifier Type | OTHER |
| Identifier State | MA |
| Identifier Issuer | BLUE CROSS |
| # 8 | |
| Identifier | 6198023 |
| Identifier Type | MEDICAID |
| Identifier State | MA |
| Identifier Issuer | |
| # 9 | |
| Identifier | 008373 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | TUFTS |
| # 10 | |
| Identifier | 0702100003 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 11 | |
| Identifier | 3100129 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UNITED |
| # 12 | |
| Identifier | 7003280 |
| Identifier Type | MEDICAID |
| Identifier State | RI |
| Identifier Issuer | |
| # 13 | |
| Identifier | 004616 |
| Identifier Type | OTHER |
| Identifier State | RI |
| Identifier Issuer | BLUE CHIP |
| # 14 | |
| Identifier | 3110893 |
| Identifier Type | MEDICAID |
| Identifier State | MA |
| Identifier Issuer | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
