Provider Demographics
NPI:1083638308
Name:SUPIANO, MARK ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANDREW
Last Name:SUPIANO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:30 N 1900 E
Mailing Address - Street 2:SOM AB193
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84132-0002
Mailing Address - Country:US
Mailing Address - Phone:801-587-9103
Mailing Address - Fax:801-585-3384
Practice Address - Street 1:UNIVERSITY OF UTAH HEALTHCARE
Practice Address - Street 2:30 NORTH 1900 EAST; AB193 SOM
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84132-0001
Practice Address - Country:US
Practice Address - Phone:801-587-9103
Practice Address - Fax:801-585-3384
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-11-23
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Provider Licenses
StateLicense IDTaxonomies
UT5956337-1205207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine