Provider Demographics
NPI:1972597631
Name:ANTHONY, MARK S (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:445 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3410
Mailing Address - Country:US
Mailing Address - Phone:607-734-2067
Mailing Address - Fax:607-732-1349
Practice Address - Street 1:445 E WATER ST
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3410
Practice Address - Country:US
Practice Address - Phone:607-734-2067
Practice Address - Fax:607-732-1349
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2011-01-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY185751208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY34784EMedicare ID - Type Unspecified
NYE93777Medicare UPIN