Provider Demographics
NPI:1659316487
Name:HOWARD, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:HOWARD
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 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:7921 JESSIES WAY
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45011-8077
Practice Address - Country:US
Practice Address - Phone:513-867-1100
Practice Address - Fax:513-856-9358
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-02-1940208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0694413Medicaid
OH490003987OtherRAILROAD MEDICARE
IN100028880AMedicaid
OH490003987OtherRAILROAD MEDICARE
OH0868533Medicare PIN
OH0694413Medicaid
IN100028880AMedicaid
OH0868532Medicare PIN