Provider Demographics
NPI:1598799140
Name:MARAKAS, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDREW
Last Name:MARAKAS
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 1:901 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5008
Mailing Address - Country:US
Mailing Address - Phone:330-726-3000
Mailing Address - Fax:330-726-2612
Practice Address - Street 1:901 TRAILWOOD DR
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-5008
Practice Address - Country:US
Practice Address - Phone:330-726-3000
Practice Address - Fax:330-726-2612
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35049381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0630231Medicaid
OH341341025034OtherCARESOURCE
OH400884OtherUNITED HEALTHCARE
OHQ018474OtherHOMETOWN
OH000000243200OtherANTHEM BC/BS
OHZ49381OtherSUMMACARE
OH78242OtherHEALTH ASSURANCE
OH78242OtherHEALTH ASSURANCE
OHZ49381OtherSUMMACARE