MEDICARE: MARK ALFONSO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	35070426	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	300067614	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548264872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALFONSO M.D.

Provider Business Mailing Address
First Line	:	100 E CAMPUS VIEW BLVD
Second Line	:	SUITE 160
City	:	COLUMBUS
State	:	OH
Zip	:	43235-4647
Country	:	US
Telephone Number	:	614-396-4750
Fax Number	:	614-396-4742

Provider Business Practice Location Address
First Line	:	3525 OLENTANGY RIVER RD
Second Line	:	STE 5360
City	:	COLUMBUS
State	:	OH
Zip	:	43214-3937
Country	:	US
Telephone Number	:	614-340-7747
Fax Number	:	614-340-7742

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	05/14/2008

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Directions to “ MARK ALFONSO M.D.” Practice Location

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