=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902078488
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEON A. MARK M.ED-BCHIS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2008
-----------------------------------------------------
Last Update Date | 03/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 BEACON ST
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02446-5587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-232-9182
-----------------------------------------------------
Fax | 617-232-5825
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1101 BEACON ST STE 8E
-----------------------------------------------------
City | BROOKLINE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02446-5587
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-232-9182
-----------------------------------------------------
Fax | 617-232-5825
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 44
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------