Provider Demographics
NPI:1861406316
Name:NORTHFIELD, MARK R (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:NORTHFIELD
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1496 PROFESSIONAL DRIVE
Mailing Address - Street 2:SUITE 601
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-778-1131
Mailing Address - Fax:707-778-3818
Practice Address - Street 1:1496 PROFESSIONAL DRIVE
Practice Address - Street 2:SUITE 601
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94954
Practice Address - Country:US
Practice Address - Phone:707-778-1131
Practice Address - Fax:707-778-3818
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-11-09
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Provider Licenses
StateLicense IDTaxonomies
CAG77114207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F70479Medicare UPIN
00G77114Medicare ID - Type Unspecified
CA1302010001Medicare NSC