Provider Demographics
NPI:1174516009
Name:SYREK, DAVID J (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:SYREK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 24
Mailing Address - Street 2:
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-0024
Mailing Address - Country:US
Mailing Address - Phone:603-483-2854
Mailing Address - Fax:
Practice Address - Street 1:1 PROSPECT ST
Practice Address - Street 2:2ND FL
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060-3921
Practice Address - Country:US
Practice Address - Phone:603-889-4431
Practice Address - Fax:603-889-1572
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12084207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA3494OtherHARVARD HEALTH
NH01Y005220NH01OtherBC/BS
NH30203860Medicaid
467491OtherTUFTS
0135502OtherCIGNA
467491OtherTUFTS
NH30203860Medicaid