Provider Demographics
NPI:1225023047
Name:MACK, AARON CHRISTOPHER (MD)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:CHRISTOPHER
Last Name:MACK
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 1:150 TAYLOR STATION RD STE 150
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4440
Mailing Address - Country:US
Mailing Address - Phone:614-866-9134
Mailing Address - Fax:614-866-6964
Practice Address - Street 1:150 TAYLOR STATION RD STE 150
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4440
Practice Address - Country:US
Practice Address - Phone:614-866-9134
Practice Address - Fax:614-866-6964
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.081529207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH313250285OtherMEDICAL MUTUAL OHIO
OH180044945OtherMEDICARE RAILROAD
OH000000236320OtherANTHEM BC BS
OH000000236320OtherBWC
OH2348258Medicaid
OH7228367OtherAETNA
OH6015450001Medicare NSC
OH180044945OtherMEDICARE RAILROAD
OH000000236320OtherBWC