Provider Demographics
NPI:1275595274
Name:GARWOOD, MARK W (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
Last Name:GARWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:W
Other - Last Name:GARWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:2 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST JEFFERSON
Mailing Address - State:OH
Mailing Address - Zip Code:43162-1202
Mailing Address - Country:US
Mailing Address - Phone:614-879-6770
Mailing Address - Fax:614-879-7067
Practice Address - Street 1:2 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST JEFFERSON
Practice Address - State:OH
Practice Address - Zip Code:43162-1202
Practice Address - Country:US
Practice Address - Phone:614-879-6770
Practice Address - Fax:644-879-7067
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003950207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0609523Medicaid
OHE49172Medicare UPIN
OH0609523Medicaid