MEDICARE: MR. MARK ANTHONY PROVENZANO MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	049161L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PR873841	OTHER		HIGHMARK

General Provider Information

NPI Number	:	1982791679
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK ANTHONY PROVENZANO MD

Provider Business Mailing Address
First Line	:	PO BOX 1549
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16003-1549
Country	:	US
Telephone Number	:	724-284-5670
Fax Number	:	724-284-4144

Provider Business Practice Location Address
First Line	:	389 NEW CASTLE RD
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-1743
Country	:	US
Telephone Number	:	724-282-2216
Fax Number	:	724-282-1861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	09/10/2025

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