Provider Demographics
NPI:1437141876
Name:WORKMAN, MARK B (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:B
Last Name:WORKMAN
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 1:1500 JAMES SIMPSON JR WAY
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-0801
Mailing Address - Country:US
Mailing Address - Phone:859-655-9500
Mailing Address - Fax:859-655-3077
Practice Address - Street 1:1500 JAMES SIMPSON JR WAY
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-0801
Practice Address - Country:US
Practice Address - Phone:859-655-9500
Practice Address - Fax:859-655-3077
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-047833207RC0000X
KY18687207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64079783Medicaid
OH0528763Medicaid
KYP00893682OtherRAILROAD MEDICARE
OH611300608065OtherCARESOURCE
OH0528763Medicaid
OHWO0899245Medicare PIN
KYP00893682OtherRAILROAD MEDICARE
A15245Medicare UPIN