Provider Demographics
NPI:1760470751
Name:DINGA, MARC JAMES (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JAMES
Last Name:DINGA
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 1:7590 AUBURN RD STE 14
Mailing Address - Street 2:
Mailing Address - City:CONCORD TWP
Mailing Address - State:OH
Mailing Address - Zip Code:44077-9176
Mailing Address - Country:US
Mailing Address - Phone:440-354-1899
Mailing Address - Fax:440-354-1845
Practice Address - Street 1:9500 MENTOR AVEMUE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-8714
Practice Address - Country:US
Practice Address - Phone:440-255-5620
Practice Address - Fax:440-375-8834
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043692207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534827Medicaid
OHH562870OtherMEDICARE
OH0534827Medicaid
C02682Medicare UPIN