Basic Information
| Provider Information | |||||||||
| NPI: | 1518927482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARK | ||||||||
| FirstName: | JULIE | ||||||||
| MiddleName: | AR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | ONE PARK WEST BLVD. | ||||||||
| Address2: | SUITE 370 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308359158 | ||||||||
| FaxNumber: | 3308354984 | ||||||||
| Practice Location | |||||||||
| Address1: | ONE PARK WEST BLVD. | ||||||||
| Address2: | SUITE 370 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308359158 | ||||||||
| FaxNumber: | 3308354984 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 09/21/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 35073333 | OH | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 2739086 | 05 | OH | MEDICAID | 4016154 | 01 | OH | MEDICARE ID | OTHER |