Provider Demographics
NPI:1942253018
Name:SCHECHTER, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:SCHECHTER
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 1:6256 GREENWICH DR STE 150
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-5965
Mailing Address - Country:US
Mailing Address - Phone:858-558-4320
Mailing Address - Fax:619-294-8399
Practice Address - Street 1:150 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2005
Practice Address - Country:US
Practice Address - Phone:619-295-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG423902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G423900OtherBS OF CA
CA1942253018Medicaid
CA00G423900Medicaid
CA00G423900Medicaid
CAWG42390JMedicare PIN
CABW137UMedicare PIN
CAWG42390TMedicare PIN
CAWG42390HMedicare PIN
CAWG42390SMedicare PIN
CA00G423090Medicare PIN
CABW137VMedicare PIN
CA1942253018Medicaid
CABW137XMedicare PIN
A48937Medicare UPIN
CA300069428Medicare PIN