Provider Demographics
NPI:1073585154
Name:SZYMANSKI, MARK BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:BRIAN
Last Name:SZYMANSKI
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 1:405 S STATE ST
Mailing Address - Street 2:
Mailing Address - City:CLARKS SUMMIT
Mailing Address - State:PA
Mailing Address - Zip Code:18411-1542
Mailing Address - Country:US
Mailing Address - Phone:570-586-4400
Mailing Address - Fax:570-587-5531
Practice Address - Street 1:405 S STATE ST
Practice Address - Street 2:
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-1542
Practice Address - Country:US
Practice Address - Phone:570-586-4400
Practice Address - Fax:570-587-5531
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-060004-L207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0073762400003Medicaid
PA014184Medicare PIN
PAG77198Medicare UPIN