Provider Demographics
NPI:1063492270
Name:KASOWITZ, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:KASOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S CROUSE AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1713
Mailing Address - Country:US
Mailing Address - Phone:315-234-4818
Mailing Address - Fax:315-234-4807
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1640
Practice Address - Country:US
Practice Address - Phone:315-234-6677
Practice Address - Fax:315-234-4808
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1195381207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00455110Medicaid
NYBB6821Medicare ID - Type Unspecified
NY34594BMedicare ID - Type Unspecified
NY00455110Medicaid