Provider Demographics
NPI:1649330226
Name:MARK L. MALLEK, MD P.C.
Entity type:Organization
Organization Name:MARK L. MALLEK, MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-881-8000
Mailing Address - Street 1:280 MAIN ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-2919
Mailing Address - Country:US
Mailing Address - Phone:603-881-8000
Mailing Address - Fax:603-881-8001
Practice Address - Street 1:280 MAIN ST
Practice Address - Street 2:SUITE 340
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-2919
Practice Address - Country:US
Practice Address - Phone:603-881-8000
Practice Address - Fax:603-881-8001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6560207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH0100335Y0NH01OtherANTHEM
NH82110335Medicaid
404414OtherTUFTS
NH82110335Medicaid
NHD03389Medicare UPIN