Provider Demographics
NPI:1366409815
Name:SARNOV, MARK LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LAWRENCE
Last Name:SARNOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-2412
Mailing Address - Country:US
Mailing Address - Phone:585-684-3556
Mailing Address - Fax:585-360-1701
Practice Address - Street 1:1379 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14615-2412
Practice Address - Country:US
Practice Address - Phone:585-684-3556
Practice Address - Fax:585-360-1701
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2024-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01777619Medicaid
NY0433OtherBLUE CROSS BLUE SHIELD
NY01777619Medicaid
NYCFP2078210OtherWORKERS COMPENSATION
NY010207821OtherBLUE CHOICE
NY7992356OtherAETNA
NYMDB886OtherPREFERRED CARE
NY7992356OtherAETNA