Provider Demographics
NPI:1124198742
Name:STECKEL, MARK CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:STECKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 SHERMAN STREET
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:203-256-1320
Mailing Address - Fax:203-256-8736
Practice Address - Street 1:140 SHERMAN STREET
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824
Practice Address - Country:US
Practice Address - Phone:203-256-1320
Practice Address - Fax:203-256-8736
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030168208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
659754OtherEVER CARE
CT061342508OtherAARP
061342508OtherMULTI PLAN
2S156OtherOXFORD HEALTH
642508OtherCTCARE
001301689OtherCOMMUNITY HEALTH NETWORK
001786OtherHEALTH NET
061342508OtherCONNECTICUT HEALTH PLAN
061342508OtherHEALTH CONNECTICUT
C00813OtherTRI STATE HEALTHNET
061342508OtherUNITED HEALTHCARE
061342508OtherCHOICE CARE NETWORK
010030168CT03OtherANTHEM BLUE CROSS AND BLU
CT123235OtherAETNA
CT001301689Medicaid
061342508OtherFIRST HEALTH NETWORK
061342508OtherGREAT WEST NETWORK
061342508OtherHMC PPO INC NORTHEAST HEA
061342508OtherGREAT WEST NETWORK
CT123235OtherAETNA