MEDICARE: MARK M DURCAN MD

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	207P00000X	Emergency Medicine Physician	9799	NH
2	207P00000X	Emergency Medicine Physician	MD20347	ME
3	207R00000X	Internal Medicine Physician	9799	NH
4	208000000X	Pediatrics Physician	9799	NH
5	207RA0401X	Addiction Medicine (Internal Medicine) Physician	9799	NH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	P00191358	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0108262Y0NH03	OTHER	NH	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	69151	OTHER		TUFTS
4	G18766	OTHER	NH	NHBS RAN
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	7067015	OTHER		AETNA
7	7067015	OTHER	NH	AETNA
8	AA105262	OTHER		HARVARD PILGRIM

General Provider Information

NPI Number	:	1770502106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK M DURCAN MD

Provider Business Mailing Address
First Line	:	74 PLEASANT ST
Second Line	:	STE 204
City	:	NEW LONDON
State	:	NH
Zip	:	03257-5881
Country	:	US
Telephone Number	:	207-618-9355
Fax Number	:	207-618-9356

Provider Business Practice Location Address
First Line	:	273 PAYNE RD
Second Line	:
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-9593
Country	:	US
Telephone Number	:	207-618-9355
Fax Number	:	207-618-9356

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

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	04/17/2020

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Directions to “ MARK M DURCAN MD” Practice Location

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