Provider Demographics
NPI:1922092667
Name:HENSCHKE, MARK R (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:HENSCHKE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2064 WOODBURY AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7801
Mailing Address - Country:US
Mailing Address - Phone:603-766-8130
Mailing Address - Fax:603-766-8131
Practice Address - Street 1:2064 WOODBURY AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7801
Practice Address - Country:US
Practice Address - Phone:603-766-8130
Practice Address - Fax:603-766-8131
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH9158207R00000X
MEDO13001207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH020470410OtherTAX ID
NHP00004229OtherRAILROAD MEDICARE
NH30006683Medicaid
NHF19346Medicare UPIN
NHRE3056Medicare PIN