Provider Demographics
NPI:1548224314
Name:COUCH, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:COUCH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:25 MERCHANT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-6507
Mailing Address - Fax:513-645-9767
Practice Address - Street 1:235 W. NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377
Practice Address - Country:US
Practice Address - Phone:937-898-3600
Practice Address - Fax:937-898-2731
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2018-08-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35051843C207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0599991Medicaid
OHA16477Medicare UPIN
OH0599991Medicaid
080182981Medicare PIN