Provider Demographics
NPI:1053320499
Name:DURKIN, MARK CHARLES (DPM)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHARLES
Last Name:DURKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6003 BIG TREE RD
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14480-9720
Mailing Address - Country:US
Mailing Address - Phone:585-346-2410
Mailing Address - Fax:585-346-0081
Practice Address - Street 1:6003 BIG TREE RD
Practice Address - Street 2:
Practice Address - City:LAKEVILLE
Practice Address - State:NY
Practice Address - Zip Code:14480-9720
Practice Address - Country:US
Practice Address - Phone:585-346-2410
Practice Address - Fax:585-346-0081
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004293-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist