Individual
MR. MARK ANTHONY PROVENZANO
Active
Individual
MR. MARK ANTHONY PROVENZANO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
049161L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0590636
—
PA
01
—
PR873841
HIGHMARK
—
Enumeration date
10/06/2006
Last updated
09/10/2025
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