National Provider Identifier
Mark Alan Medakovich, CRNA
Mark Alan Medakovich, CRNA is listed in the NPPES registry with a primary specialty of Certified Registered Nurse Anesthetist in Buffalo, NY and a listed phone number of (716) 845-2300.
Profile Overview
- NPI
- 1780144410
- Provider Type
- Individual
- Primary Specialty
- Certified Registered Nurse Anesthetist
- Enumeration Date
- March 20, 2019
- Last Updated
- January 21, 2021
Practice Location
- Elm And Carlton Streets
- Buffalo, NY 14263-1104
Phone: (716) 845-2300
Mailing Address
- 16 Ketchum Pl
- Buffalo, NY 14213-2661
Specialties
- Certified Registered Nurse Anesthetist (367500000X)
- Registered Nurse (163W00000X)
Full Record
- NPI
- 1780144410
- Entity Type
- Individual
- Last Name
- Medakovich
- First Name
- Mark
- Middle Name
- Alan
- Credential
- CRNA
- Mailing Street Address
- 16 Ketchum Pl
- Mailing City
- Buffalo
- Mailing State
- NY
- Mailing ZIP Code
- 14213-2661
- Mailing Country
- US
- Mailing Phone
- (716) 870-9108
- Practice Street Address
- Elm And Carlton Streets
- Practice City
- Buffalo
- Practice State
- NY
- Practice ZIP Code
- 14263-1104
- Practice Country
- US
- Practice Phone
- (716) 845-2300
- Enumeration Date
- March 20, 2019
- Last Updated
- January 21, 2021
- Sex
- Male
- Sole Proprietor
- Yes
- Certification Date
- January 21, 2021
- updated_by_file
- npidata_pfile_20050523-20260308.csv
- Taxonomies
- Certified Registered Nurse Anesthetist (367500000X), Registered Nurse (163W00000X)
- Other Identifiers
- 647277 (NY, Nys License)