Provider Demographics
NPI:1841217387
Name:DAVENPORT, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:DAVENPORT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:10 HAGEN DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14625-2660
Mailing Address - Country:US
Mailing Address - Phone:585-922-5840
Mailing Address - Fax:585-586-7558
Practice Address - Street 1:10 HAGEN DR
Practice Address - Street 2:SUITE 310
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14625-2660
Practice Address - Country:US
Practice Address - Phone:585-922-5840
Practice Address - Fax:585-586-7558
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2009-12-29
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Provider Licenses
StateLicense IDTaxonomies
NY173462208200000X, 2082S0099X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand