Provider Demographics
NPI:1760461693
Name:AEBI, MARK E (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:AEBI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:ELLIS
Other - Last Name:AEBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1800 GRANVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-1043
Mailing Address - Country:US
Mailing Address - Phone:740-785-4678
Mailing Address - Fax:740-687-1518
Practice Address - Street 1:1800 GRANVILLE PIKE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1043
Practice Address - Country:US
Practice Address - Phone:740-785-4678
Practice Address - Fax:740-687-1518
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-10
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35058926207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0773266Medicaid
OHH499150Medicare PIN
OH0773266Medicaid
0100019OtherUNITED HEALTHCARE
AE0658266Medicare ID - Type Unspecified
4204357OtherAETNA
OH0658268Medicare PIN
000000008483OtherANTHEM