DR. MARK K JACKSON (NPI# 1063405538) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063405538 |
| Entity Type | Individual |
| Full Name | DR. MARK K JACKSON |
| Credential | M.D. |
| Practice Address |
110 W 6th St Oswego NY 13126-2507 |
| Mailing Address |
104 W Utica St Oswego NY 13126-3031 |
| Practice Telephone | 3153495000 |
| Mailing Telephone | 3153430257 |
| Mailing Fax Number | 3153430948 |
| Enumeration Date | 2005-08-30 |
| Last Update Date | 2007-09-13 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0202X |
Radiology Specialization: Diagnostic Radiology |
196101 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 01880015 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134755721 | Mark Wayne Jackson | Occupational Therapist | 8608 Marys Creek Dr, Benbrook, TX 76116-7624 | 2020-03-16 |
| 1811409535 | Mark Jackson | Driver | 26048 Pine Tree Rd, Rhoadesville, VA 22542-8549 | 2017-11-03 |
| 1932488194 | Mark Monroe Jackson | Social Worker | 119 Kona Dr, Galveston, TX 77554-8623 | 2011-08-05 |
| 1477860757 | Mark Allan Jackson | Technician, Other | 322 S Jefferson St, Louisa, KY 41230-1316 | 2010-09-08 |
| 1063620516 | Mark Kent Jackson | Pharmacist | 605 Hwy 31 South, Suite D, Athens, AL 35611 | 2007-05-18 |
| 1528289881 | Mark Jackson | Preventive Medicine | 10 Standing Rock Agency Avenue, Fort Yates, ND 58538 | 2007-05-02 |
| 1255470209 | Mark F Jackson | Anesthesiology | 3930 Us 1 S, Saint Augustine, FL 32086-7089 | 2007-02-06 |
| 1598788796 | Mark K Jackson | Dentist | 7007 Old Sauk Road, Madison, WI 53717 | 2006-07-26 |
| 1003877077 | Mark R. Jackson | Emergency Medicine | 1474 E Erda Way, Tooele, UT 84074-9737 | 2006-03-30 |
| 1073585238 | Mark A Jackson | Family Medicine | 1000 Pavilions Circle, Mark A Jackson Md Plc, Traverse City, MI 49684 | 2006-02-02 |
| Street Address |
110 W 6TH ST |
| City | OSWEGO |
| State | NY |
| Zip Code | 13126-2507 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821080334 | Ahmad Al-salameh | Pathology | 110 W 6th St, Oswego, NY 13126-2507 | 2005-08-19 |
| 1881205847 | Cynthia Lorraine Althouse | Nurse Practitioner | 110 W 6th St, Oswego, NY 13126-2507 | 2020-08-13 |
| 1629696224 | Ruth Noemi Vasquez | Nurse Practitioner | 110 W 6th St, Oswego, NY 13126-2507 | 2020-07-09 |
| 1750906608 | Gretchen Schlieder | Nurse Practitioner | 110 W 6th St, Oswego, NY 13126-2507 | 2020-06-16 |
| 1215552567 | Gretchen Ann Garland | Nurse Practitioner | 110 W 6th St, Oswego, NY 13126-2507 | 2020-06-12 |
| 1619508967 | Arthur Ezzo | Physical Therapy Assistant | 110 W 6th St, Oswego, NY 13126-2507 | 2020-01-27 |
| 1396381000 | Misty Putnam | Physician Assistant | 110 W 6th St, Oswego, NY 13126-2507 | 2019-11-18 |
| 1144880964 | Nathaniel Michael Farden | Nurse Practitioner | 110 W 6th St, Oswego, NY 13126-2507 | 2019-06-14 |
| 1497245922 | Rockaway Emergency Medicine Services PC | Physician Assistant | 110 W 6th St, Oswego, NY 13126-2507 | 2018-05-10 |
| 1134631740 | Rebecca Grethel | Hospitalist | 110 W 6th St, Oswego, NY 13126-2507 | 2017-11-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992303572 | Elise Fitzsimmons | Specialist/Technologist | 9 Laker Hall, Oswego, NY 13126 | 2020-10-15 |
| 1023651742 | Jessica Lynn Metzger | Physician Assistant | 300 Ny-104 Suite 1, Oswego, NY 13126 | 2019-10-25 |
| 1245887009 | Maureen Adams | Technician | 30 Stone Ridge Drive, Oswego, NY 13126 | 2019-08-26 |
| 1285128314 | Justin Raymond Beebe | Nurse Practitioner | 300 State Route 104 Ste 2, Oswego, NY 13126 | 2018-06-21 |
| 1801311220 | Lynne M Wallace | Registered Nurse | 29 Birch Lane 17b, Oswego, NY 13126 | 2017-08-07 |
| 1497203962 | Lindsay Cheslock | Local Education Agency (LEA) | 529 County Route 25, Oswego, NY 13126 | 2016-09-14 |
| 1942757919 | Aimee Devinny | Registered Nurse | 21 Twin Orchard Drive, Oswego, NY 13126 | 2016-09-07 |
| 1083160295 | Cameron Delmotte | Specialist | 159 West Frist Street, Oswego, NY 13126 | 2016-08-28 |
| 1508319187 | Samantha Thayer | Occupational Therapist | 159 West First Oswego St, Oswego, NY 13126 | 2016-07-29 |
| 1104279595 | Vikram Jala | Internal Medicine | 105 County Route 45a Ste 400, Oswego, NY 13126 | 2016-07-20 |
| Find all providers in zip 13126 | ||||
| Taxonomy Code | 2085R0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Diagnostic Radiology |
| A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Radiology, 2007. http://www.theabr.org/. American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Radiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Radiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487629846 | Sudhir Babu Guthikonda | Radiology | 110 W 6th St, Oswego, NY 13126-2507 | 2006-02-21 |
| 1225021868 | Oswego Radiology, PC | Radiology | 110 W 6th St, Oswego, NY 13126-2507 | 2005-08-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558960690 | New York Medical Diagnostic Imaging PC | Radiology | 13617 39th Ave Ste 1d, Flushing, NY 11354-5504 | 2020-10-20 |
| 1700490034 | Hudson Valley Radiologists, PC | Radiology | 33 Bridgewater Way, Poughkeepsie, NY 12601-5961 | 2020-09-03 |
| 1730702986 | Hudson Valley Radiologists, PC | Radiology | 17 Argent Dr, Poughkeepsie, NY 12603-6040 | 2020-05-22 |
| 1114540366 | Hudson Valley Radiologists, PC | Radiology | 12 Caliguiri Ct, Lagrangeville, NY 12540-4912 | 2020-05-22 |
| 1831712082 | Hudson Valley Radiologists, PC | Radiology | 23 Sommerset Rd, Poughkeepsie, NY 12603 | 2020-05-22 |
| 1124641378 | Hudson Valley Radiologists, PC | Radiology | 49 Evergreen Ave, Poughkeepsie, NY 12601-5206 | 2020-05-22 |
| 1023631272 | Hudson Valley Radiologists, PC | Radiology | 3 Riding Ridge Trl, Beacon, NY 12508-7023 | 2020-05-22 |
| 1740803998 | Hudson Valley Radiologists, PC | Radiology | 36 Pine St Apt 229, Poughkeepsie, NY 12601-3974 | 2020-05-22 |
| 1215550462 | Hudson Valley Radiologists, PC | Radiology | 50 Leonard St Unit 106, Beacon, NY 12508-3455 | 2020-05-22 |
| 1285257519 | Hudson Valley Radiologists, PC | Radiology | 14 Hilee Rd, Rhinebeck, NY 12572-2347 | 2020-05-21 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.