Basic Information
| Provider Information | |||||||||
| NPI: | 1902885254 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCROBERTS | ||||||||
| FirstName: | MARK | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3515 MASSILLON RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446856400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308999350 | ||||||||
| FaxNumber: | 3306341329 | ||||||||
| Practice Location | |||||||||
| Address1: | 3043 SANITARIUM RD | ||||||||
| Address2: | STE. 1 | ||||||||
| City: | AKRON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443124600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306284044 | ||||||||
| FaxNumber: | 3306283005 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/14/2006 | ||||||||
| LastUpdateDate: | 12/07/2016 | ||||||||
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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 | 207R00000X | 35-049045-M | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000000132163 | 01 | OH | ANTHEM | OTHER | 071 | 01 | OH | SUMMA | OTHER | 341458069B | 01 | OH | AULTCARE | OTHER | P00096158 | 01 | OH | RAILROAD MEDICARE | OTHER | 729762 | 01 | OH | BUCKEYE COMM HEALTH PLAN | OTHER | 04-03138 | 01 | OH | UNITED HEALTHCARE | OTHER | 0568407 | 05 | OH | MEDICAID | 0553284 | 01 | OH | MEDICARE ID | OTHER | 0553282 | 01 | OH | MEDICARE ID | OTHER |