Individual
DR. MARK T. BAESL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 PROSPECT AVE, DEPT. OF RADIOLOGY, SYRACUSE, NY 13203-1807
(315) 703-2138
Mailing address
301 PROSPECT AVE, DEPT. OF RADIOLOGY, SYRACUSE, NY 13203-1807
(315) 703-2138
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
260730
NY
2085R0202X
Diagnostic Radiology Physician
MD438193
PA
2085R0204X
Vascular & Interventional Radiology Physician
25MA08811900
NJ
2085R0204X
Vascular & Interventional Radiology Physician
Primary
260730
NY
2085R0204X
Vascular & Interventional Radiology Physician
MD438193
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0233510
—
NJ
05
—
102469026-0001
—
PA
Enumeration date
08/04/2008
Last updated
02/05/2013
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