Provider Demographics
NPI:1275536237
Name:LAW, MARK STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEPHEN
Last Name:LAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1371 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3681
Mailing Address - Country:US
Mailing Address - Phone:740-522-8555
Mailing Address - Fax:740-522-3620
Practice Address - Street 1:1717 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1385
Practice Address - Country:US
Practice Address - Phone:740-522-8555
Practice Address - Fax:740-522-3620
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063488207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH648699OtherAETNA HEALTHCARE
OH1436869001OtherCIGNA HEALTHCARE
OH180013666OtherRR MEDICARE
OH0800358OtherUNITED HEALTHCARE
OH0878724Medicaid
OH000000008456OtherANTHEM HEALTHCARE
OHLA0718331Medicare ID - Type UnspecifiedMEDICARE