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Individual

MARK ANTHONY KENYON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
818 ELLICOTT ST, BUFFALO, NY 14203-1021
(716) 323-0220
(716) 323-0293
Mailing address
1001 MAIN ST FL 5, BUFFALO, NY 14203-1009
(716) 323-0220
(716) 323-0293

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
228634
NY
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
Primary
228634
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00026380601
UNIVERA
01
000527294001
BC/BS
05
02409052
NY
01
040426003098
FIDELIS
05
100831371001
PA
01
1292497
IHA
Enumeration date
05/03/2006
Last updated
01/13/2021
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