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General NPI Number Information
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NPI Number | 1205849981
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Entity Type | Individual
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Provider Name | MARK A WERNHAM MS,PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 02/08/2023
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Provider Practice Location Address
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Address Line | 1051 CRAFT RD
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City | ITHACA
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State | NY
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Zip | 14850-1016
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Country | US
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Telephone | 607-257-1107
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Fax | 607-257-0369
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Provider Business Mailing Address
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Address Line | 274 CHIPMAN CORNERS RD
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City | GROTON
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State | NY
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Zip | 13073-8405
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Country | US
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Telephone | 609-351-4567
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 25MP00163400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 019675-1
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License Number State | NY
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