Provider Demographics
NPI:1720047731
Name:BARCELO, MARK JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JEFFREY
Last Name:BARCELO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30701 LORAIN RD STE A
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-6325
Mailing Address - Country:US
Mailing Address - Phone:440-274-5000
Mailing Address - Fax:
Practice Address - Street 1:7580 AUBURN RD STE 302
Practice Address - Street 2:
Practice Address - City:CONCORD TWP
Practice Address - State:OH
Practice Address - Zip Code:44077-9618
Practice Address - Country:US
Practice Address - Phone:440-354-4208
Practice Address - Fax:440-354-1151
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057712207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0888580Medicaid
000000126682OtherANTHEM BCBS
353767OtherWELLCARE OF OHIO
4284824OtherAETNA
1100285OtherUNITED HEALTH CARE
OH0722452Medicare PIN
F34859Medicare UPIN
220010524Medicare PIN
4284824OtherAETNA
220014694Medicare PIN