Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 30.020049 | OH |
NPI | 1861478398 |
---|---|
Provider Name | Dr. Mark G. Hochberg |
First Address | Columbus, OH 43210-1267 |
Second Address | Columbus, OH 43210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/12/2005 |
Last Update Date | 16/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U49403 | (02) | NH |