| Doctor Name: | MARK S POTENZA |
| NPI Number: | 1134122096 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 167600 |
| Business Practice Address: | 5700 W Genesee St Ste 132 Camillus, NY - 130313212 |
| Business Phone Number: | 3154875858 |
| Business Fax Number: | 3154871950 |
| Mailing Address: | Po Box 2003, EAST SYRACUSE |
| State: | NY |
| Postal Code: | 130574503 |
| Phone Number: | 3154493904 |
| Fax Number: | 3154452936 |
| NPI Enumeration Date: | 05/24/2005 |
| NPI Last Update Date: | 12/20/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2086S0122X |
| License Number: | 167600 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Surgery |
| Taxonomy Specialization: | Plastic and Reconstructive Surgery |
| Taxonomy Definition: | A surgeon who specializes in plastic and reconstructive surgery. |