Provider Demographics
NPI:1649614520
Name:ETTEL, MARK GONZALEZ (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:GONZALEZ
Last Name:ETTEL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:601 ELMWOOD AVENUE, BOX 626
Mailing Address - Street 2:URMC
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-3191
Mailing Address - Fax:585-273-3637
Practice Address - Street 1:601 ELMWOOD AVENUE
Practice Address - Street 2:UNIVERSITY OF ROCHESTER MEDICAL CENTER,
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-3191
Practice Address - Fax:585-273-3637
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2023-06-30
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Provider Licenses
StateLicense IDTaxonomies
MI4301111405207ZP0101X
NY293012207ZP0101X, 207ZP0102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program