Provider Demographics
NPI:1962451021
Name:COLLINS, MARK S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:S
Last Name:COLLINS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1492 E BROAD ST
Mailing Address - Street 2:TOWER 13
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1546
Mailing Address - Country:US
Mailing Address - Phone:614-257-2900
Mailing Address - Fax:614-257-2079
Practice Address - Street 1:1492 E BROAD ST
Practice Address - Street 2:TOWER 13
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1546
Practice Address - Country:US
Practice Address - Phone:614-257-2900
Practice Address - Fax:614-257-2079
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2014-01-10
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Provider Licenses
StateLicense IDTaxonomies
OH35065485207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0331055Medicaid
OHC00825114Medicare PIN
OHG52413Medicare UPIN