Provider Demographics
NPI:1245391440
Name:BILLINSON, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:BILLINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 3G
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-452-2968
Mailing Address - Fax:315-452-2977
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 3G
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2968
Practice Address - Fax:315-452-2977
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY172243207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01251225Medicaid
10458267OtherCAQH
NY01251225Medicaid
NY53150AMedicare PIN
NYJ400060179Medicare PIN