Healthcare Provider Details

I. General information

NPI: 1689625600
Provider Name (Legal Business Name): MARK ROBERT WINDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 LAFAYETTE RD SECOND FLOOR
NORTH HAMPTON NH
03862-2480
US

IV. Provider business mailing address

65 LAFAYETTE RD SECOND FLOOR
NORTH HAMPTON NH
03862-2480
US

V. Phone/Fax

Practice location:
  • Phone: 603-964-3392
  • Fax: 603-964-3396
Mailing address:
  • Phone: 603-964-3392
  • Fax: 603-964-3396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number7208
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: