Individual
MATTHEW MARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
50 BLAINE AVE STE 2200, BEDFORD, OH 44146-2709
(440) 232-5400
(440) 232-0084
Mailing address
PO BOX 901666, CLEVELAND, OH 44190-1666
(440) 232-5400
(440) 232-0084
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35075459M
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2191097
—
OH
Enumeration date
10/11/2006
Last updated
01/08/2021
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