Provider Demographics
NPI:1144406265
Name:STRANGE, MARK A (HS, USCG)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STRANGE
Suffix:
Gender:M
Credentials:HS, USCG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 SPRUCE ST
Mailing Address - Street 2:ROOM 2-102A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-2818
Mailing Address - Country:US
Mailing Address - Phone:314-269-2312
Mailing Address - Fax:314-269-2748
Practice Address - Street 1:1222 SPRUCE ST
Practice Address - Street 2:ROOM 2-102A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2818
Practice Address - Country:US
Practice Address - Phone:314-269-2312
Practice Address - Fax:314-269-2748
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman