Provider Demographics
NPI:1003856907
Name:HUGHES, MARK (PA-C)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:HUGHES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 HOLIDAY ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2531
Mailing Address - Country:US
Mailing Address - Phone:330-494-2097
Mailing Address - Fax:330-494-9750
Practice Address - Street 1:4105 HOLIDAY ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2531
Practice Address - Country:US
Practice Address - Phone:330-494-2097
Practice Address - Fax:330-494-9750
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50001086363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH970022371OtherRAILROAD MEDICARE
OHHUPA11111Medicare PIN
OH970022371OtherRAILROAD MEDICARE