Basic Information
| Provider Information | |||||||||
| NPI: | 1457351488 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENZES | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 320 E NORTH AVE | ||||||||
| Address2: | AGH EMERGENCY ASSOCS | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4123594138 | ||||||||
| FaxNumber: | 4123598874 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 S JACKSON AVE | ||||||||
| Address2: | AGH SUBURBAN CAMPUS | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4127346100 | ||||||||
| FaxNumber: | 4127346932 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2005 | ||||||||
| LastUpdateDate: | 04/23/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD039291 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0134018 | 05 | OH | MEDICAID | 0010739500014 | 05 | PA | MEDICAID | 0054951000 | 05 | WV | MEDICAID |