Provider Demographics
NPI:1548344583
Name:DETWEILER, MARK KENNETH (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:KENNETH
Last Name:DETWEILER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1B COMMONS DR
Mailing Address - Street 2:UNIT 9A
Mailing Address - City:LONDONDERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03053-3441
Mailing Address - Country:US
Mailing Address - Phone:603-818-4712
Mailing Address - Fax:603-421-6899
Practice Address - Street 1:1B COMMONS DR
Practice Address - Street 2:UNIT 9A
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-3441
Practice Address - Country:US
Practice Address - Phone:603-818-4712
Practice Address - Fax:603-421-6899
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-04-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NH6919207RG0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology