Provider Demographics
NPI:1730137373
Name:DAHL, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:DAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5151 REED RD
Mailing Address - Street 2:SUITE 225-C
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-2595
Mailing Address - Country:US
Mailing Address - Phone:614-457-2306
Mailing Address - Fax:614-884-0776
Practice Address - Street 1:5151 REED RD
Practice Address - Street 2:SUITE 225-C
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2595
Practice Address - Country:US
Practice Address - Phone:614-457-2306
Practice Address - Fax:614-884-0776
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35051782D207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH050021841OtherMEDICARE RAILROAD
OH0889203Medicaid
OH0889203Medicaid
OHDA0623993Medicare ID - Type Unspecified