Provider Demographics
NPI:1770123986
Name:LOCKLEAR, MARK (ATP)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LOCKLEAR
Suffix:
Gender:M
Credentials:ATP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 PINE TREE RD
Mailing Address - Street 2:
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-4646
Mailing Address - Country:US
Mailing Address - Phone:410-603-4601
Mailing Address - Fax:
Practice Address - Street 1:154 PINE TREE RD
Practice Address - Street 2:
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-4646
Practice Address - Country:US
Practice Address - Phone:410-603-4601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-15
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment