Active NPI
Mark Vonnegut, MD
- Pediatric Adolescent Medicine Physician
- Quincy, MA
National Provider Identifier
1295757268
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Adolescent Medicine Physician
- License
- 49135
- Practice address
- 21 Totman Street #2
Quincy, MA 02169 - Phone
- (617) 745-0050
- Fax
- (617) 745-0052
- NPI assigned
- Jul 25, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Adolescent Medicine Physician | 2080A0000X | 49135 | MA | Primary |
Addresses
Primary practice location
21 Totman Street #2
Quincy, MA 02169
Mailing address
21 Totman Street #2
Quincy, MA 02169
Phone (617) 745-0050
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 170259 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49135 | MA | MD | Pediatric Adolescent Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1295757268",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 TOTMAN STREET #2",
"city": "QUINCY",
"state": "MA",
"postal_code": "02169",
"telephone_number": "617-745-0050",
"fax_number": "617-745-0052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 TOTMAN STREET #2",
"city": "QUINCY",
"state": "MA",
"postal_code": "02169",
"telephone_number": "617-745-0050",
"fax_number": "617-745-0052"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VONNEGUT",
"first_name": "MARK",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-25",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2080A0000X",
"taxonomy_group": "",
"desc": "Pediatrics, Adolescent Medicine",
"state": "MA",
"license": "49135",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "170259",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Quincy, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.