Provider Demographics
NPI:1982664264
Name:MEIER, MARK STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEPHEN
Last Name:MEIER
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:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-341-0288
Mailing Address - Fax:859-341-7482
Practice Address - Street 1:2900 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-5427
Practice Address - Country:US
Practice Address - Phone:859-341-0288
Practice Address - Fax:859-341-7482
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24163174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0560085Medicaid
4123606OtherAETNA
000816684013OtherUNITED HEALTHCARE
KY110122350OtherRAIL ROAD MEDICARE
000000484659OtherANTHEM
IN200424410Medicaid
310674100OtherFEDERAL BLACK LUNG
KY64241631Medicaid
310674100OtherFEDERAL BLACK LUNG
IN200424410Medicaid
KYP00454950Medicare PIN
KY3313284Medicare PIN
KY0399021Medicare PIN
C66768Medicare UPIN
KY64241631Medicaid
KY0969429Medicare PIN