Provider Demographics
NPI:1851703151
Name:STEVENS, MARC A (PA-C)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:STEVENS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:104 UNION AVENUE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-1844
Mailing Address - Country:US
Mailing Address - Phone:315-703-5049
Mailing Address - Fax:315-703-5079
Practice Address - Street 1:301 PROSPECT AVENUE
Practice Address - Street 2:SUITE 804
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-448-5111
Practice Address - Fax:315-703-5079
Is Sole Proprietor?:No
Enumeration Date:2014-05-21
Last Update Date:2014-11-25
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Provider Licenses
StateLicense IDTaxonomies
NY017471363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical