Provider Demographics
NPI:1033217112
Name:WELLS, MARK H (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:H
Last Name:WELLS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 INDIAN ROCK SHOPPING CENTER
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901
Mailing Address - Country:US
Mailing Address - Phone:845-357-0848
Mailing Address - Fax:845-290-1660
Practice Address - Street 1:17 INDIAN ROCK SHOPPING CENTER
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901
Practice Address - Country:US
Practice Address - Phone:845-357-0848
Practice Address - Fax:845-290-1660
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004925213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P53211Medicare ID - Type Unspecified
U32677Medicare UPIN