1396738548 NPI number — MARK ZAHNISER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396738548 NPI number — MARK ZAHNISER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ZAHNISER

Provider First Name:

MARK

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1396738548

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

08/19/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

24701 EUCLID AVE

Provider Second Line Business Mailing Address:

3RD FLOOR

Provider Business Mailing Address City Name:

EUCLID

Provider Business Mailing Address State Name:

OH

Provider Business Mailing Address Postal Code:

44117-1714

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

216-383-6616

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

11100 EUCLID AVE

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

CLEVELAND

Provider Business Practice Location Address State Name:

OH

Provider Business Practice Location Address Postal Code:

44106

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

216-844-7330

Provider Business Practice Location Address Fax Number:

216-844-3781

Provider Enumeration Date:

08/23/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207LC0200X , with the licence number:  35066970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207L00000X , with the licence number: 35066970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LA0401X , with the licence number: 35066970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LH0002X , with the licence number: 35066970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LP2900X , with the licence number: 35066970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LP3000X , with the licence number: 35066970 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 751194 . This is a "BUCKEYE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 5166041 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000231404 . This is a "ANTHEM BCBS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000532710 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 050085791 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 414859 . This is a "WELLCARE MEDICAID" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 364080614A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
• Identifier: 0583328 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 000000225169 . This is a "UNISON" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: 2183640 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 341924447032 . This is a "CARESOURCE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
• Identifier: P00405859 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".