Provider Demographics
NPI:1467676478
Name:SKALSKI, MARK STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STANLEY
Last Name:SKALSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:305 BICENTENNIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1962
Mailing Address - Country:US
Mailing Address - Phone:413-733-4101
Mailing Address - Fax:413-796-6821
Practice Address - Street 1:305 BICENTENNIAL HWY
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1962
Practice Address - Country:US
Practice Address - Phone:413-733-4101
Practice Address - Fax:413-796-6821
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA234168207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02272273Medicaid
MA2147581Medicaid
NY2593482OtherGHI
NY05681Medicare ID - Type Unspecified
MA2147581Medicaid
NYH56485Medicare UPIN