Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208G00000X | Cardiothoracic Vascular Surgeon | 256860 | NY |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | MD426092 | PA |
NPI | 1124108998 |
---|---|
Provider Name | Mark W Hennon |
First Address | Pittsburgh, PA 15237 |
Second Address | Pittsburgh, PA 15237 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 24/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03226262 | (05) | NY |