1124198742 NPI number — MARK CHARLES STECKEL MD

Table of content: MARK CHARLES STECKEL MD (NPI 1124198742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124198742 NPI number — MARK CHARLES STECKEL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STECKEL
Provider First Name:
MARK
Provider Middle Name:
CHARLES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124198742
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
140 SHERMAN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-256-1320
Provider Business Mailing Address Fax Number:
203-256-8736

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
140 SHERMAN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-256-1320
Provider Business Practice Location Address Fax Number:
203-256-8736
Provider Enumeration Date:
11/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  030168 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 659754 . This is a "EVER CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "AARP" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "MULTI PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2S156 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 642508 . This is a "CTCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001301689 . This is a "COMMUNITY HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001786 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "CONNECTICUT HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "HEALTH CONNECTICUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: C00813 . This is a "TRI STATE HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "CHOICE CARE NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010030168CT03 . This is a "ANTHEM BLUE CROSS AND BLU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123235 . This is a "AETNA" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 001301689 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 061342508 . This is a "FIRST HEALTH NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "GREAT WEST NETWORK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061342508 . This is a "HMC PPO INC NORTHEAST HEA" identifier . This identifiers is of the category "OTHER".




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