1326036914 NPI number — MARK ROBERT SUMNER MD

Table of content: MARK ROBERT SUMNER MD (NPI 1326036914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326036914 NPI number — MARK ROBERT SUMNER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUMNER
Provider First Name:
MARK
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326036914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
104 1/2 COLLEGE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-463-5107
Provider Business Mailing Address Fax Number:
315-463-6029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 GENESEE STREET
Provider Second Line Business Practice Location Address:
ONEIDA HEALTHCARE CENTER
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-463-5107
Provider Business Practice Location Address Fax Number:
315-463-6029
Provider Enumeration Date:
10/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  1787851 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01340445 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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