Provider Demographics
NPI:1801908009
Name:ZEDAR, MARK J (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:J
Last Name:ZEDAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 EGGLESTON RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-9740
Mailing Address - Country:US
Mailing Address - Phone:440-268-0888
Mailing Address - Fax:440-572-9701
Practice Address - Street 1:1050 EGGLESTON RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:OH
Practice Address - Zip Code:44202-9740
Practice Address - Country:US
Practice Address - Phone:440-572-9701
Practice Address - Fax:440-572-9703
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0055422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0134634Medicaid
OH0134634Medicaid
OH0731572Medicare PIN
OH260041602Medicare PIN
OH0829625Medicare PIN