Healthcare Provider Details

I. General information

NPI: 1790720621
Provider Name (Legal Business Name): MARK STEVEN GOLEC DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 N MAIN ST
LEEDS MA
01053-9764
US

IV. Provider business mailing address

47 BROOKWOOD AVE
CARLISLE PA
17015
US

V. Phone/Fax

Practice location:
  • Phone: 413-584-4040
  • Fax:
Mailing address:
  • Phone: 717-243-2236
  • Fax: 717-243-6536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberSC003839L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: