Individual
MARK FUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
149 EMERALD ST, KEENE, NH 03431-3611
(603) 354-5454
Mailing address
149 EMERALD ST, KEENE, NH 03431-3611
(603) 354-5454
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
7270
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30001358
—
NH
Enumeration date
11/02/2006
Last updated
03/22/2012
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