Provider Demographics
NPI:1184605149
Name:TERPYLAK, MARK A (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TERPYLAK
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 1:1860 STATE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-1422
Mailing Address - Country:US
Mailing Address - Phone:330-923-3138
Mailing Address - Fax:330-923-9652
Practice Address - Street 1:1860 STATE RD
Practice Address - Street 2:SUITE D
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223-1422
Practice Address - Country:US
Practice Address - Phone:330-923-3138
Practice Address - Fax:330-923-9652
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004222207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0821614Medicaid
OH0821614Medicaid
OHTE0779378Medicare PIN
OHTE0779375Medicare PIN
OHE92082Medicare UPIN
OHTE0779376Medicare PIN