Provider Demographics
NPI:1265431753
Name:HOSTETTLER, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HOSTETTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1207 W STATE ST
Mailing Address - Street 2:SUITE N
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4686
Mailing Address - Country:US
Mailing Address - Phone:330-821-3244
Mailing Address - Fax:330-868-5782
Practice Address - Street 1:1207 W STATE ST
Practice Address - Street 2:SUITE N
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4686
Practice Address - Country:US
Practice Address - Phone:330-821-3244
Practice Address - Fax:330-868-5782
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35-05-2184-H207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000269631OtherANTHEM
OH0690739Medicaid
OH110035014OtherMEDICARE RAILROADERS
OH000000269631OtherANTHEM
OH0690739Medicaid