Provider Demographics
NPI:1851396659
Name:RORRER, MARK T (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:RORRER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 GARNET DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-2141
Mailing Address - Country:US
Mailing Address - Phone:937-272-1631
Mailing Address - Fax:
Practice Address - Street 1:3033 KETTERING BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MORAINE
Practice Address - State:OH
Practice Address - Zip Code:45439-1962
Practice Address - Country:US
Practice Address - Phone:937-293-2133
Practice Address - Fax:937-293-2161
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007087207Q00000X
KY03040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0887136OtherMEDICARE ID-TYPE UNSPECIFIED
OH2142112Medicaid
OH2245421Medicaid
OH9358391OtherMEDICARE ID-TYPE UNSPECIFIED
OH2142112Medicaid