Provider Demographics
NPI:1598090532
Name:HOESTEN, MARK S (RD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:HOESTEN
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2050 KENNY RD
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3502
Mailing Address - Country:US
Mailing Address - Phone:614-293-2800
Mailing Address - Fax:614-293-2801
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:SUITE 1010
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-2800
Practice Address - Fax:614-293-2801
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHLD6819133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH146060Medicare PIN