Provider Demographics
NPI:1346254562
Name:KEGEL, MARK STEVEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:KEGEL
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 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, FLOOR 1
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5046
Mailing Address - Country:US
Mailing Address - Phone:603-228-1111
Mailing Address - Fax:603-227-7558
Practice Address - Street 1:246 PLEASANT STREET MEMORIAL BUILDING, WEST, FLOOR 1
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5046
Practice Address - Country:US
Practice Address - Phone:603-228-1111
Practice Address - Fax:603-227-7558
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8968207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30005891Medicaid
NHNX0648Medicare PIN
E46239Medicare UPIN