Provider Demographics
NPI:1497721336
Name:MIETH, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:MIETH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14174-1224
Mailing Address - Country:US
Mailing Address - Phone:716-297-7207
Mailing Address - Fax:866-751-0857
Practice Address - Street 1:ONE COLUMBIA DRIVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14305
Practice Address - Country:US
Practice Address - Phone:716-297-7233
Practice Address - Fax:716-297-7238
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY200346174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG36430Medicare UPIN
NYCC8847Medicare PIN