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General NPI Number Information
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NPI Number | 1508839291
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Entity Type | Organization
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Legal Business Name | MARK A. LATINA
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Dates
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Enumeration Date | 02/11/2006
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Last Update Date | 12/02/2010
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Provider Practice Location Address
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Address Line | 20 PONDMEADOW DRIVE SUITE 203
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City | READING
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State | MA
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Zip | 01867
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Country | US
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Telephone | 781-942-9876
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Fax | 781-942-9877
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Provider Business Mailing Address
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Address Line | 20 PONDMEADOW DRIVE SUITE 203
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City | READING
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State | MA
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Zip | 01867
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Country | US
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Telephone | 781-942-9876
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Fax | 781-942-9877
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARK A LATINA
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Credential | MD
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Telephone | 781-941-9876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 48630
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License Number State | MA
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