Provider Demographics
NPI:1437215456
Name:STRACKS, MARK DOUGLAS (MD, MS, MPH)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DOUGLAS
Last Name:STRACKS
Suffix:
Gender:M
Credentials:MD, MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 GOLD MINE RD
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06783-1214
Mailing Address - Country:US
Mailing Address - Phone:706-718-8056
Mailing Address - Fax:
Practice Address - Street 1:45 GOLD MINE RD
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:CT
Practice Address - Zip Code:06783-1214
Practice Address - Country:US
Practice Address - Phone:706-718-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0603112084P0800X
NY2777162084P0800X
CT546022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA567393386AMedicaid
GA567393386AMedicaid
202I261052Medicare UPIN