Healthcare Provider Details

I. General information

NPI: 1134212616
Provider Name (Legal Business Name): THOR MARKWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 GENESEE ST SUITE 200
UTICA NY
13501-5930
US

IV. Provider business mailing address

2211 GENESEE ST SUITE 200
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-733-7598
  • Fax: 315-733-2102
Mailing address:
  • Phone: 315-733-7598
  • Fax: 315-733-2102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number245234
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: