Provider Demographics
NPI:1619388121
Name:BREAZZANO, MARK PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILIP
Last Name:BREAZZANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:200 GREENFIELD PKWY
Mailing Address - Street 2:
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-6655
Mailing Address - Country:US
Mailing Address - Phone:315-445-8166
Mailing Address - Fax:315-445-2697
Practice Address - Street 1:200 GREENFIELD PKWY
Practice Address - Street 2:
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-6655
Practice Address - Country:US
Practice Address - Phone:315-445-8166
Practice Address - Fax:315-445-2697
Is Sole Proprietor?:No
Enumeration Date:2014-05-19
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY292157207WX0107X, 207WX0107X
MDD89206207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology