Provider Demographics
NPI:1376706713
Name:MARK, JENNIFER PATRICIA-REASON (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:PATRICIA-REASON
Last Name:MARK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSAL PRIMARY CARE
Mailing Address - Street 2:135 NORTH UNION STREET
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760
Mailing Address - Country:US
Mailing Address - Phone:716-701-6863
Mailing Address - Fax:716-306-5482
Practice Address - Street 1:135 N UNION ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2736
Practice Address - Country:US
Practice Address - Phone:716-375-7500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY309168207V00000X
VA0102203096207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology