Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 17500 | NH |
Y | 111NI0900X | Internist | 17500 | NH |
N | 207RG0300X | Geriatric Medicine | 106644 | MO |
NPI | 1003806084 |
---|---|
Provider Name | Dr. Mark Lee Dick |
First Address | Dover, NH 03820-2526 |
Second Address | Dover, NH 03820-5933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3105753 | (05) | NH |
VAD000 | (02) |