Provider Demographics
NPI:1710949433
Name:STEVER, MARK A (RPA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:STEVER
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E GENESEE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1903
Mailing Address - Country:US
Mailing Address - Phone:315-471-8388
Mailing Address - Fax:315-471-8019
Practice Address - Street 1:1000 E GENESEE ST STE 500
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1885
Practice Address - Country:US
Practice Address - Phone:315-471-8388
Practice Address - Fax:315-471-8019
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009011207P00000X, 363AM0700X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP83297Medicare UPIN
NYDD4729Medicare ID - Type Unspecified
NYJ400002812Medicare PIN