Healthcare Provider Details

I. General information

NPI: 1669463782
Provider Name (Legal Business Name): MARK F. ROUNDS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 WASHINGTON ST SUITE 668
NEWTON MA
02462-1650
US

IV. Provider business mailing address

2000 WASHINGTON ST SUITE 668
BOSTON MA
02119-2020
US

V. Phone/Fax

Practice location:
  • Phone: 617-630-1699
  • Fax:
Mailing address:
  • Phone: 617-573-3635
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number150240
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number150240
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: