Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 35058857 | OH |
NPI | 1003929555 |
---|---|
Provider Name | Mr. Mark H Gersten |
First Address | Highland Hills, OH 44122-7251 |
Second Address | Beachwood, OH 44122-4478 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 02/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0807569 | (05) | OH |
E75575 | (02) | OH |