Provider Demographics
NPI:1144390436
Name:POOLE, MARK ELLSWORTH
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ELLSWORTH
Last Name:POOLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 2ND ST SW STE 5314
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0002
Mailing Address - Country:US
Mailing Address - Phone:314-269-2310
Mailing Address - Fax:314-269-2748
Practice Address - Street 1:1222 SPRUCE ST RM 2.102A
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63103-2854
Practice Address - Country:US
Practice Address - Phone:314-269-2310
Practice Address - Fax:314-269-2748
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other