Provider Demographics
NPI:1659358109
Name:POYNTER, MARK THOMAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:THOMAS
Last Name:POYNTER
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 1:2055 HOSPITAL DR
Mailing Address - Street 2:STE, 355
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-1978
Mailing Address - Country:US
Mailing Address - Phone:513-732-9300
Mailing Address - Fax:513-732-5663
Practice Address - Street 1:2055 HOSPITAL DR
Practice Address - Street 2:STE, 355
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103
Practice Address - Country:US
Practice Address - Phone:513-732-9300
Practice Address - Fax:513-732-5663
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079261208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2324265Medicaid
OH2829992OtherAETNA
OHPO4085525Medicare PIN
OHH63707Medicare UPIN
OH2829992OtherAETNA
OHH163370Medicare PIN
OHPO4085521Medicare PIN
OH2324265Medicaid