Provider Demographics
NPI:1629376785
Name:LEWY, MARK HELLER (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:HELLER
Last Name:LEWY
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 1:1 GRANITE PL
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-3258
Mailing Address - Country:US
Mailing Address - Phone:603-226-5722
Mailing Address - Fax:
Practice Address - Street 1:1 GRANITE PL
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-3258
Practice Address - Country:US
Practice Address - Phone:603-226-5722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH8126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine