Provider Demographics
NPI:1932209418
Name:JAROCH, MARK T (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:JAROCH
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 1:1261 WOOSTER RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-1568
Mailing Address - Country:US
Mailing Address - Phone:330-763-2018
Mailing Address - Fax:330-674-9706
Practice Address - Street 1:1261 WOOSTER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-1568
Practice Address - Country:US
Practice Address - Phone:330-763-2018
Practice Address - Fax:330-674-9706
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2018-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-055029208600000X
MI4301084587208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0671303Medicaid
OH0671303Medicaid