Provider Demographics
NPI:1750996237
Name:MCLEOD, MARK HAMILTON (MED)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HAMILTON
Last Name:MCLEOD
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 FALCON WAY
Mailing Address - Street 2:
Mailing Address - City:BOW
Mailing Address - State:NH
Mailing Address - Zip Code:03304-4228
Mailing Address - Country:US
Mailing Address - Phone:603-228-2210
Mailing Address - Fax:
Practice Address - Street 1:55 FALCON WAY
Practice Address - Street 2:
Practice Address - City:BOW
Practice Address - State:NH
Practice Address - Zip Code:03304-4228
Practice Address - Country:US
Practice Address - Phone:603-228-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH115458103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool