Provider Demographics
NPI:1437343233
Name:STUDEBAKER, MARK EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWIN
Last Name:STUDEBAKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5438 WEEPING WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4406
Mailing Address - Country:US
Mailing Address - Phone:330-655-9638
Mailing Address - Fax:
Practice Address - Street 1:4059 KINROSS LAKES PKWY
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9371
Practice Address - Country:US
Practice Address - Phone:330-659-8348
Practice Address - Fax:860-262-7796
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-05-0148207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine