MEDICARE: MARK M SOUWEIDANE 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	207T00000X	Neurological Surgery Physician	188037	NY

General Provider Information

NPI Number	:	1376527929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK M SOUWEIDANE MD

Provider Business Mailing Address
First Line	:	525 E 68TH ST
Second Line	:	BOX 99
City	:	NEW YORK
State	:	NY
Zip	:	10021-4870
Country	:	US
Telephone Number	:	212-746-2363
Fax Number	:	212-746-7729

Provider Business Practice Location Address
First Line	:	525 E 68TH ST
Second Line	:	BOX 99
City	:	NEW YORK
State	:	NY
Zip	:	10021-4870
Country	:	US
Telephone Number	:	212-746-2363
Fax Number	:	212-746-5592

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

Provider Enumeration Date	:	12/06/2005
Last Update Date	:	07/09/2015

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