Provider Demographics
NPI:1881773307
Name:MCGURRIN, MARK A (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:MCGURRIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:104 UNION AVE
Mailing Address - Street 2:#1005
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203
Mailing Address - Country:US
Mailing Address - Phone:315-424-0790
Mailing Address - Fax:315-475-0916
Practice Address - Street 1:104 UNION AVE
Practice Address - Street 2:#1005
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203
Practice Address - Country:US
Practice Address - Phone:315-424-0790
Practice Address - Fax:315-475-0916
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21668612086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02561677Medicaid
F10466Medicare UPIN
NY02561677Medicaid