Provider Demographics
NPI:1417386673
Name:SUCHOWIECKI, MARK (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SUCHOWIECKI
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:251 SALINA MEADOWS PKWY
Mailing Address - Street 2:STE 100
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-4516
Mailing Address - Country:US
Mailing Address - Phone:315-464-2000
Mailing Address - Fax:315-464-2010
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-4363
Practice Address - Fax:315-464-8690
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2015-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT055.0031190363A00000X
NY017566363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant