Provider Demographics
NPI:1952361354
Name:MCCONN, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MCCONN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4117 MEDICAL CENTER DR
Mailing Address - Street 2:POD C
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6600
Mailing Address - Country:US
Mailing Address - Phone:315-329-4975
Mailing Address - Fax:315-329-4970
Practice Address - Street 1:218 ROYAL PALM WAY
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33432
Practice Address - Country:US
Practice Address - Phone:561-340-5780
Practice Address - Fax:561-340-5788
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2023-03-09
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Provider Licenses
StateLicense IDTaxonomies
FLME84294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02414359Medicaid
NY39659EMedicare ID - Type Unspecified
NYJ400037459Medicare PIN
NY02414359Medicaid