Provider Demographics
NPI:1497775159
Name:AEDER, MARK I (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:I
Last Name:AEDER
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-7874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-050860204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000221062OtherUNISON
OH2500556Medicaid
OH743533OtherBUCKEYE
OHP00411225OtherRAILROAD MEDICARE
PA1025620300001Medicaid
000000503712OtherANTHEM
4301728OtherAETNA
OHP00163613OtherRAILROAD MEDICARE
OH363300OtherWELLCARE
OH000000221062OtherUNISON
OHAE4125192Medicare PIN
PA1025620300001Medicaid