Provider Demographics
NPI:1104136266
Name:KUCHARSKI, MARK R (CRNA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:KUCHARSKI
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:BOX 604
Mailing Address - Street 2:601 ELWOOD AVE
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-275-1385
Mailing Address - Fax:585-244-7271
Practice Address - Street 1:601 ELMWOOD AVE BOX 604
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-1385
Practice Address - Fax:585-244-7271
Is Sole Proprietor?:No
Enumeration Date:2010-10-07
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY509973367500000X
NY509973-1367500000X
MA2268875367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered