Provider Demographics
NPI:1346403490
Name:WEIDENBECHER, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:WEIDENBECHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4275 STEELS POINTE
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6841
Mailing Address - Country:US
Mailing Address - Phone:330-923-0399
Mailing Address - Fax:330-923-6677
Practice Address - Street 1:4275 STEELS POINTE
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6841
Practice Address - Country:US
Practice Address - Phone:330-923-0399
Practice Address - Fax:330-923-6677
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2023-06-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35123288207Y00000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0105058Medicaid