Provider Demographics
NPI:1659646875
Name:LANDRENEAU, MARK MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:MATTHEW
Last Name:LANDRENEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:29 HOSPITAL PLZ STE 602
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-3602
Mailing Address - Country:US
Mailing Address - Phone:203-276-4464
Mailing Address - Fax:203-276-4468
Practice Address - Street 1:29 HOSPITAL PLZ STE 602
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-3602
Practice Address - Country:US
Practice Address - Phone:203-276-4464
Practice Address - Fax:203-276-4468
Is Sole Proprietor?:No
Enumeration Date:2012-03-21
Last Update Date:2019-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT556292084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology