Provider Demographics
NPI:1518931989
Name:CHAZEN, MARK D (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:CHAZEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3085 HARLEM ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHEEKTOWAGA
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2591
Mailing Address - Country:US
Mailing Address - Phone:716-844-5000
Mailing Address - Fax:716-844-5050
Practice Address - Street 1:3085 HARLEM ROAD
Practice Address - Street 2:SUITE 200
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2591
Practice Address - Country:US
Practice Address - Phone:716-844-5000
Practice Address - Fax:716-844-5050
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-03-01
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Provider Licenses
StateLicense IDTaxonomies
NY191098208800000X
NY191098-1208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY005247231OtherBLUE CROSS
NY01739899Medicaid
160985156OtherUHC-EMPIRE
NM1908966OtherINDEPENDENT HEALTH INS
NY340013524OtherRAILROAD MEDICARE
NY00010297801OtherUNIVERA INSURANCE
NY1099639OtherGHI
NY01739899Medicaid
NY005247231OtherBLUE CROSS