Provider Demographics
NPI:1255369484
Name:BUDDIE, MARK ALAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BUDDIE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 N UNION ST STE B
Mailing Address - Street 2:
Mailing Address - City:DELAWARE
Mailing Address - State:OH
Mailing Address - Zip Code:43015-4401
Mailing Address - Country:US
Mailing Address - Phone:740-362-3696
Mailing Address - Fax:740-362-5010
Practice Address - Street 1:104 N UNION ST., STE B
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7665
Practice Address - Country:US
Practice Address - Phone:740-362-3696
Practice Address - Fax:740-362-5010
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.067139207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0981666Medicaid
OH000000019130OtherANTHEM BC/BS
OH0981666Medicaid
OH1413233OtherUNITED HEATLHCARE OF OHIO
F85887Medicare UPIN