Provider Demographics
NPI:1376508564
Name:MARK, THOMAS EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:MARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 N UNION ST
Mailing Address - Street 2:STE 104
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1369
Mailing Address - Country:US
Mailing Address - Phone:330-253-9145
Mailing Address - Fax:330-253-6222
Practice Address - Street 1:190 N UNION ST
Practice Address - Street 2:STE 104
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1369
Practice Address - Country:US
Practice Address - Phone:330-253-9145
Practice Address - Fax:330-253-6222
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-069968 M207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000125764OtherANTHEM BCBS INDV NUMBER
OHCN1092OtherRAILROAD MEDICARE GROUP #
OH7091249Medicaid
OH340891295-00OtherWORKERS COMP GROUP NUMBER
OH2182981Medicaid
OH727552OtherBUCKEYE COMMUNITY HLTH PL
OH9122673Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
OH727552OtherBUCKEYE COMMUNITY HLTH PL
OH7091249Medicaid