Provider Demographics
NPI:1043299274
Name:DEAN, LAURIAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:LAURIAN
Middle Name:MARK
Last Name:DEAN
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 1:1 MIRANOVA PL APT 825
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-5081
Mailing Address - Country:US
Mailing Address - Phone:614-981-2608
Mailing Address - Fax:
Practice Address - Street 1:1 MIRANOVA PL APT 825
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5081
Practice Address - Country:US
Practice Address - Phone:614-981-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350776032085R0202X
OH35.0776032085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2157428Medicaid
OH300125121OtherRR MEDICARE
OH4054499Medicare PIN
OHF60312Medicare UPIN
OH0899899Medicare PIN