Individual
MARK ALEXANDER PETTIT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1425 PORTLAND AVENUE, ROCHESTER, NY 14621
(585) 922-4000
Mailing address
1425 PORTLAND AVE, ROCHESTER, NY 14621-3001
(585) 922-4000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
278798
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04239745
—
NY
Enumeration date
04/20/2012
Last updated
08/23/2016
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