Provider Demographics
NPI:1457351488
Name:HENZES, MARK JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JOSEPH
Last Name:HENZES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E NORTH AVE
Mailing Address - Street 2:AGH EMERGENCY ASSOCS
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212
Mailing Address - Country:US
Mailing Address - Phone:412-359-4138
Mailing Address - Fax:412-359-8874
Practice Address - Street 1:100 S JACKSON AVE
Practice Address - Street 2:AGH SUBURBAN CAMPUS
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15202
Practice Address - Country:US
Practice Address - Phone:412-734-6100
Practice Address - Fax:412-734-6932
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039291207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134018Medicaid
PA0010739500014Medicaid
WV0054951000Medicaid
WV0054951000Medicaid
787264Medicare PIN
787265Medicare PIN
PA0010739500014Medicaid
PAB39645Medicare UPIN