Provider Demographics
NPI:1629086665
Name:PRESTON, MARK C (MD)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:765 NORTH HAMILTON RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43230-8703
Mailing Address - Country:US
Mailing Address - Phone:614-478-4785
Mailing Address - Fax:614-478-4159
Practice Address - Street 1:765 NORTH HAMILTON RD
Practice Address - Street 2:SUITE 130
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43230-8703
Practice Address - Country:US
Practice Address - Phone:614-478-4785
Practice Address - Fax:614-478-4159
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35051676208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000120017OtherANTHEM
OHPR0670472Medicare ID - Type Unspecified
E76432Medicare UPIN