Provider Demographics
NPI:1588605729
Name:DEFRANCISCO, MARK T (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:DEFRANCISCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1371 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3681
Mailing Address - Country:US
Mailing Address - Phone:220-564-1965
Mailing Address - Fax:220-564-1966
Practice Address - Street 1:1371 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3681
Practice Address - Country:US
Practice Address - Phone:220-564-1965
Practice Address - Fax:220-564-1966
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0067642086S0129X
SC830582086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4155251Medicare PIN