Provider Demographics
NPI:1649231879
Name:HAUSER, MARK JEFFREY (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEFFREY
Last Name:HAUSER
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 1:16 CONVERSE AVE
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2504
Mailing Address - Country:US
Mailing Address - Phone:617-969-6331
Mailing Address - Fax:617-969-6350
Practice Address - Street 1:16 CONVERSE AVE
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2504
Practice Address - Country:US
Practice Address - Phone:617-969-6331
Practice Address - Fax:617-969-6350
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA498742084F0202X, 2084P0800X
CT0285312084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3023656Medicaid
MAB74101Medicare UPIN
MAJ01042Medicare ID - Type Unspecified