MEDICARE: DR. MARK J EUBANKS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	224065	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	462282	OTHER	MA	TUFTS HEALTH PLAN
2	AA42003	OTHER	MA	HARVARD PILGRIM
3	J29252	OTHER	MA	BCBSMA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619955465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK J EUBANKS M.D.

Provider Business Mailing Address
First Line	:	10 CORDAGE PARK CIR
Second Line	:	SUITE 201
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7318
Country	:	US
Telephone Number	:	508-747-2924
Fax Number	:	508-830-0854

Provider Business Practice Location Address
First Line	:	10 CORDAGE PARK CIR
Second Line	:	SUITE 201
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-7318
Country	:	US
Telephone Number	:	508-747-2924
Fax Number	:	508-830-0854

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	01/19/2015

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