Healthcare Provider Details

I. General information

NPI: 1720014236
Provider Name (Legal Business Name): MARK W SYKES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

157 UNION ST RADIOLOGY DEPARTMENT
MARLBOROUGH MA
01752-1228
US

IV. Provider business mailing address

157 UNION ST RADIOLOGY DEPARTMENT
MARLBOROUGH MA
01752-1228
US

V. Phone/Fax

Practice location:
  • Phone: 508-486-5605
  • Fax: 508-486-5506
Mailing address:
  • Phone: 508-486-5605
  • Fax: 508-486-5506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number049595
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: