Rodehaver, Mark William
Rodehaver, Mark William is an sole proprietor health care provider with primary practice located at 1330 Beacon St Suite 263, Brookline MA 02446-3282. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Rodehaver, Mark William can be contacted via phone (617) 566-2859.Contact Information
Primary practice address
1330 Beacon St Suite 263
Brookline MA 02446-3282
Phone: (617) 566-2859
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 36905 | Massachusetts |
Profile Details
| NPI number | 1760401053 |
|---|---|
| LBN Legal business name | Rodehaver, Mark William |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 19th, 2006 |
| Last updated | Jul 8th, 2007 - about 18 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1760401053 | NPPES |
| Minnesota | MEDICAID | 2033917 |
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