Healthcare Provider Details

I. General information

NPI: 1770502106
Provider Name (Legal Business Name): MARK M DURCAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 04/17/2020
Certification Date: 04/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 PAYNE RD
SCARBOROUGH ME
04074-9593
US

IV. Provider business mailing address

74 PLEASANT ST STE 204
NEW LONDON NH
03257-5881
US

V. Phone/Fax

Practice location:
  • Phone: 207-618-9355
  • Fax: 207-618-9356
Mailing address:
  • Phone: 207-618-9355
  • Fax: 207-618-9356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number9799
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD20347
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9799
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9799
License Number StateNH
# 5
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number9799
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: