Healthcare Provider Details

I. General information

NPI: 1497721336
Provider Name (Legal Business Name): MARK S MIETH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 08/18/2022
Certification Date: 08/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE COLUMBIA DRIVE SUITE ONE
NIAGARA FALLS NY
14305
US

IV. Provider business mailing address

500 MAIN ST
YOUNGSTOWN NY
14174-1224
US

V. Phone/Fax

Practice location:
  • Phone: 716-297-7233
  • Fax: 716-297-7238
Mailing address:
  • Phone: 716-297-7207
  • Fax: 866-751-0857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200346
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number200346
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: