Provider Demographics
NPI:1649406802
Name:MARK C PRESTON MD INC
Entity Type:Organization
Organization Name:MARK C PRESTON MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-478-4785
Mailing Address - Street 1:765 N HAMILTON RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:GAHANNA
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 N HAMILTON RD
Practice Address - Street 2:SUITE 130
Practice Address - City:GAHANNA
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR0670472Medicare PIN