Provider Demographics
NPI:1851373351
Name:SUZUKI, MARK M (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:M
Last Name:SUZUKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:836 E 65TH ST STE 22
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4493
Mailing Address - Country:US
Mailing Address - Phone:912-819-2622
Mailing Address - Fax:912-691-9041
Practice Address - Street 1:11700 MERCY BLVD BLDG 1
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419-1753
Practice Address - Country:US
Practice Address - Phone:912-819-0500
Practice Address - Fax:912-819-0501
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2024-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD064264L208G00000X
GA082117208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017153000001Medicaid
PA017444Medicare PIN