Provider Demographics
NPI:1245214063
Name:VERRA, MARK ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:VERRA
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 1:254 CHURCH ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1076
Mailing Address - Country:US
Mailing Address - Phone:518-587-8400
Mailing Address - Fax:518-587-4155
Practice Address - Street 1:254 CHURCH ST
Practice Address - Street 2:SUITE 1
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1076
Practice Address - Country:US
Practice Address - Phone:518-587-8400
Practice Address - Fax:518-587-4155
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1898671207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01341340Medicaid
NY01341340Medicaid
F20262Medicare UPIN