Basic Information
| Provider Information | |||||||||
| NPI: | 1598749699 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GITTINS | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 S CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430811329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148906555 | ||||||||
| FaxNumber: | 6148238881 | ||||||||
| Practice Location | |||||||||
| Address1: | 70 S CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | WESTERVILLE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430811329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6148906555 | ||||||||
| FaxNumber: | 6148238881 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2005 | ||||||||
| LastUpdateDate: | 02/25/2016 | ||||||||
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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 | 207X00000X | 34004688 | OH | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0856239 | 05 | OH | MEDICAID |