Provider Demographics
NPI:1316122823
Name:METWALLY, MARK JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOHN
Last Name:METWALLY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:848 ROUTE 50
Mailing Address - Street 2:
Mailing Address - City:BURNT HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:12027-9511
Mailing Address - Country:US
Mailing Address - Phone:518-831-1500
Mailing Address - Fax:518-377-1677
Practice Address - Street 1:848 ROUTE 50
Practice Address - Street 2:
Practice Address - City:BURNT HILLS
Practice Address - State:NY
Practice Address - Zip Code:12027
Practice Address - Country:US
Practice Address - Phone:518-831-1500
Practice Address - Fax:518-377-1677
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2025-02-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY274634207RG0100X
NY2746343207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
J400151796Medicare UPIN