Healthcare Provider Details

I. General information

NPI: 1932180684
Provider Name (Legal Business Name): MARK FLYER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 ROSE LANE
EAST ROCKAWAY NY
11518-2129
US

IV. Provider business mailing address

23625 COMMERCE PARK SUITE 204
BEACHWOOD OH
44122-5845
US

V. Phone/Fax

Practice location:
  • Phone: 216-255-5700
  • Fax: 216-255-5701
Mailing address:
  • Phone: 216-255-5700
  • Fax: 216-255-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number183860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: