Provider Demographics
NPI:1609841832
Name:MALLEK, MARK LASAK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LASAK
Last Name:MALLEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 MAIN ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2919
Mailing Address - Country:US
Mailing Address - Phone:603-881-8000
Mailing Address - Fax:603-881-8001
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2919
Practice Address - Country:US
Practice Address - Phone:603-881-8000
Practice Address - Fax:603-881-8001
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH6560207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82110335Medicaid
NH0100335Y0NH01OtherANTHEM ID
MANH0335OtherBCBS OF MA
NH82110335OtherHARVARD ID
MA404414OtherTUFTS
NHD03389Medicare UPIN
NH82110335OtherHARVARD ID