Provider Demographics
NPI:1679010854
Name:FINTON, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:FINTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 SUSSEX PL
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1649
Mailing Address - Country:US
Mailing Address - Phone:937-572-5413
Mailing Address - Fax:
Practice Address - Street 1:858 SUSSEX PL
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1649
Practice Address - Country:US
Practice Address - Phone:937-572-5413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-25
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications