Basic Information
| Provider Information | |||||||||
| NPI: | 1184605149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TERPYLAK | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1860 STATE RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442231422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309233138 | ||||||||
| FaxNumber: | 3309239652 | ||||||||
| Practice Location | |||||||||
| Address1: | 1860 STATE RD | ||||||||
| Address2: | SUITE D | ||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442231422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309233138 | ||||||||
| FaxNumber: | 3309239652 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 11/17/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34004222 | OH | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 0821614 | 05 | OH | MEDICAID |