Provider Demographics
NPI:1710924410
Name:DELLINGER, MARK A (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:DELLINGER
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 1:153 SANCTUARY CT
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-4640
Mailing Address - Country:US
Mailing Address - Phone:614-448-9494
Mailing Address - Fax:614-448-9494
Practice Address - Street 1:1900 POLARIS PKWY STE 450-066
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-4035
Practice Address - Country:US
Practice Address - Phone:614-448-9494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-5205-D207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2173311Medicaid
OHDE4016044Medicare ID - Type UnspecifiedINDIVIDUAL #-MT.CARMEL EA
OH2173311Medicaid
OHDE4016043Medicare ID - Type UnspecifiedINDIVIDUAL #-MT.CARMEL