Provider Demographics
NPI:1215348792
Name:MARK N. STRECKER, MD, PC
Entity type:Organization
Organization Name:MARK N. STRECKER, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:NOAH
Authorized Official - Last Name:STRECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:781-652-0501
Mailing Address - Street 1:152 WOBURN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2248
Mailing Address - Country:US
Mailing Address - Phone:781-652-0501
Mailing Address - Fax:888-315-3476
Practice Address - Street 1:152 WOBURN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2248
Practice Address - Country:US
Practice Address - Phone:781-652-0501
Practice Address - Fax:888-315-3476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-18
Last Update Date:2014-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5860101YM0800X
MA569082084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty