Provider Demographics
NPI:1316323868
Name:MARKO, MATT G (MS, PA-C, DMSC)
Entity type:Individual
Prefix:DR
First Name:MATT
Middle Name:G
Last Name:MARKO
Suffix:
Gender:M
Credentials:MS, PA-C, DMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 WHEATFIELD DR
Mailing Address - Street 2:
Mailing Address - City:CHITTENANGO
Mailing Address - State:NY
Mailing Address - Zip Code:13037-9657
Mailing Address - Country:US
Mailing Address - Phone:315-559-9757
Mailing Address - Fax:
Practice Address - Street 1:168 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-4116
Practice Address - Country:US
Practice Address - Phone:315-218-6492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-07
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019062363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant