Provider Demographics
NPI:1548350481
Name:CONNAUGHTON, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:CONNAUGHTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:118 OXBOW RD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778-1026
Mailing Address - Country:US
Mailing Address - Phone:978-287-3700
Mailing Address - Fax:978-287-3729
Practice Address - Street 1:133 OLD ROAD TO NINE ACRE CORNER
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4159
Practice Address - Country:US
Practice Address - Phone:978-287-3700
Practice Address - Fax:978-287-3729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2012-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA541012085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3003256Medicaid
MA3003256Medicaid