Provider Demographics
NPI:1750765772
Name:TUROLDO, MARK (PA)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TUROLDO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:3085 SOUTHWESTERN BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3085 SOUTHWESTERN BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1232
Practice Address - Country:US
Practice Address - Phone:716-677-2575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY018770363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant