Provider Demographics
NPI:1053354084
Name:HILL, MARK A (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:HILL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-0510
Mailing Address - Country:US
Mailing Address - Phone:718-863-2514
Mailing Address - Fax:
Practice Address - Street 1:3844 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2422
Practice Address - Country:US
Practice Address - Phone:718-822-0122
Practice Address - Fax:718-822-8122
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2007-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228880207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH93032Medicare UPIN
NY76V061Medicare ID - Type Unspecified