Provider Demographics
NPI:1730102930
Name:STANOS, MARK C JR (DPM)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:STANOS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3255 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43227-1923
Mailing Address - Country:US
Mailing Address - Phone:614-239-0399
Mailing Address - Fax:
Practice Address - Street 1:3255 E. LIVINGSTON AVENUE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-4322
Practice Address - Country:US
Practice Address - Phone:614-239-9444
Practice Address - Fax:614-239-1080
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36003256S213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPO0359999OtherRAILROAD MEDICARE PIN
OH2419332Medicaid
OHST4090537Medicare PIN
U91593Medicare UPIN
OH4316791Medicare PIN
OH2419332Medicaid
OHST4090536Medicare PIN
OHPO0359999OtherRAILROAD MEDICARE PIN