Healthcare Provider Details

I. General information

NPI: 1922092667
Provider Name (Legal Business Name): MARK R HENSCHKE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2005
Last Update Date: 09/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2064 WOODBURY AVE SUITE 102
NEWINGTON NH
03801-7801
US

IV. Provider business mailing address

2064 WOODBURY AVE SUITE 102
NEWINGTON NH
03801-7801
US

V. Phone/Fax

Practice location:
  • Phone: 603-766-8130
  • Fax: 603-766-8131
Mailing address:
  • Phone: 603-766-8130
  • Fax: 603-766-8131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9158
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO13001
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: