Provider Demographics
NPI:1336374859
Name:MCCLOSKEY, MARK E (CCP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MCCLOSKEY
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 PHILADELPHIA DR
Mailing Address - Street 2:SUITE 555
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45406-1840
Mailing Address - Country:US
Mailing Address - Phone:937-275-5100
Mailing Address - Fax:937-275-4587
Practice Address - Street 1:2200 PHILADELPHIA DR
Practice Address - Street 2:SUITE 555
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45406-1840
Practice Address - Country:US
Practice Address - Phone:937-275-5100
Practice Address - Fax:937-275-4587
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist