Provider Demographics
NPI:1295736924
Name:FINE, MARK D (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:FINE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7640 SYLVANIA AVE
Mailing Address - Street 2:I
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-9729
Mailing Address - Country:US
Mailing Address - Phone:419-517-4000
Mailing Address - Fax:419-517-4001
Practice Address - Street 1:7640 SYLVANIA AVE
Practice Address - Street 2:I
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-9729
Practice Address - Country:US
Practice Address - Phone:419-517-4000
Practice Address - Fax:419-517-4001
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-10-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35038934F207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00011OtherPARAMOUNT
OH283760OtherUNITED HEALTH CARE
OH000000130369OtherANTHEM BCBS
OH0353862Medicaid
OH4002408OtherAETNA
OH4002408OtherAETNA
OH0353862Medicaid