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General NPI Number Information
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NPI Number | 1477584738
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Entity Type | Individual
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Provider Name | MARK A HEALEY M.D
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 03/03/2017
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Provider Practice Location Address
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Address Line | 25 COTTAGE ST
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City | POTSDAM
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State | NY
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Zip | 13676-2196
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Country | US
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Telephone | 315-265-1055
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Fax | 315-261-5043
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Provider Business Mailing Address
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Address Line | 50 LEROY ST SUITE 100
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City | POTSDAM
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State | NY
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Zip | 13676-1786
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Country | US
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Telephone | 315-265-1055
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Fax | 315-261-5043
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 042-0009894
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 285052
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License Number State | NY
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