Provider Demographics
NPI:1518975853
Name:OELRICH, D MARK (MD)
Entity Type:Individual
Prefix:
First Name:D
Middle Name:MARK
Last Name:OELRICH
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 1:7665 MONARCH COURT
Mailing Address - Street 2:STE 107
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069
Mailing Address - Country:US
Mailing Address - Phone:513-779-1800
Mailing Address - Fax:513-779-1901
Practice Address - Street 1:7665 MONARCH COURT
Practice Address - Street 2:STE 107
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069
Practice Address - Country:US
Practice Address - Phone:513-779-1800
Practice Address - Fax:513-779-1901
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH35046715207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000029307OtherANTHEM
OH0640613Medicaid
OH0640613Medicaid
0582653Medicare ID - Type Unspecified