Provider Demographics
NPI:1477181097
Name:FLETCHER, MARK ALLEN (MD AND PHD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:FLETCHER
Suffix:
Gender:M
Credentials:MD AND PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5141 W BROAD ST STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1992
Practice Address - Country:US
Practice Address - Phone:614-544-1061
Practice Address - Fax:614-544-1359
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1496402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry