Provider Demographics
NPI:1790720621
Name:GOLEC, MARK STEVEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:GOLEC
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 BROOKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17015
Mailing Address - Country:US
Mailing Address - Phone:717-243-2236
Mailing Address - Fax:717-243-6536
Practice Address - Street 1:47 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015
Practice Address - Country:US
Practice Address - Phone:717-243-2236
Practice Address - Fax:717-243-6536
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003839L213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015506680003Medicaid
PA781764XRBMedicare PIN
U56944Medicare UPIN