Individual
MARK KWALBRUN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1571 WASHINGTON ST, SUITE 101, WATERTOWN, NY 13601-9304
(315) 786-5000
(315) 786-5001
Mailing address
1571 WASHINGTON ST, SUITE 101, WATERTOWN, NY 13601-9304
(315) 786-5046
(315) 786-5043
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
225726
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02461787
—
NY
Enumeration date
07/29/2005
Last updated
01/15/2014
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