Provider Demographics
NPI:1003900812
Name:MARS, HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:
Last Name:MARS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 PARK EAST DR
Mailing Address - Street 2:SUITE 517
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4331
Mailing Address - Country:US
Mailing Address - Phone:216-831-6085
Mailing Address - Fax:216-831-6172
Practice Address - Street 1:3609 PARK EAST DR
Practice Address - Street 2:SUITE 517
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4331
Practice Address - Country:US
Practice Address - Phone:216-831-6085
Practice Address - Fax:216-831-6172
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 0329742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0155684Medicaid
OH0397234Medicare PIN
OH0155684Medicaid