Provider Demographics
NPI:1497798722
Name:CADY, MARK DUANE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DUANE
Last Name:CADY
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 1:5 MOUNT EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-9553
Mailing Address - Country:US
Mailing Address - Phone:315-436-0824
Mailing Address - Fax:
Practice Address - Street 1:5 MOUNT EAGLE DR
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-9553
Practice Address - Country:US
Practice Address - Phone:315-436-0824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01082143A207L00000X
TN71008207L00000X
NY184666207L00000X
PAMD4797798722207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01466251Medicaid
NY01466251Medicaid
J400001607Medicare PIN