Provider Demographics
NPI:1659456028
Name:STANCOMBE, MARK DOMINIC (RPA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DOMINIC
Last Name:STANCOMBE
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 W SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:14750-1045
Mailing Address - Country:US
Mailing Address - Phone:716-763-1837
Mailing Address - Fax:
Practice Address - Street 1:140 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1317
Practice Address - Country:US
Practice Address - Phone:585-968-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23-011590363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant