Basic Information
| Provider Information | |||||||||
| NPI: | 1194961391 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK S. MIETH MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 NIAGARA FALLS BLVD | ||||||||
| Address2: | STE 208 | ||||||||
| City: | N TONAWANDA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 141202019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166923302 | ||||||||
| FaxNumber: | 7162130935 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 COLOMBA DR STE 1 | ||||||||
| Address2: | WITMER PARK MEDICAL CENTER | ||||||||
| City: | NIAGARA FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 143051275 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7162977207 | ||||||||
| FaxNumber: | 7162977238 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2008 | ||||||||
| LastUpdateDate: | 12/18/2008 | ||||||||
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| AuthorizedOfficialLastName: | MIETH | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | S. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7162977207 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 200346 | NY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.