Provider Demographics
NPI:1942407135
Name:JABLONSKI, MARK GIRISH (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GIRISH
Last Name:JABLONSKI
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 1:1675 E MAIN ST
Mailing Address - Street 2:BOX 328
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-5818
Mailing Address - Country:US
Mailing Address - Phone:330-593-1030
Mailing Address - Fax:330-677-8770
Practice Address - Street 1:1675 E MAIN ST
Practice Address - Street 2:BOX 328
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-5818
Practice Address - Country:US
Practice Address - Phone:330-593-1030
Practice Address - Fax:330-677-8770
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012530632085R0202X
OH35.0926472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2891545Medicaid
PA1021420440001Medicaid
PAMD434156OtherMEDICAL LICENSE
PA002061184OtherHIGHMARK
OH35092647OtherMEDICAL LICENSE
OH4256633Medicare PIN
OH4256631Medicare PIN
OH2891545Medicaid
OH4256632Medicare PIN