Provider Demographics
NPI:1366484230
Name:LENA, MARK R (MD)
Entity Type:Individual
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First Name:MARK
Middle Name:R
Last Name:LENA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8941
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:360 BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-907-3550
Practice Address - Fax:207-907-3562
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-02-03
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Provider Licenses
StateLicense IDTaxonomies
MEMD12551207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME241820099Medicaid
C65707Medicare UPIN
MM2974Medicare ID - Type Unspecified