Healthcare Provider Details

I. General information

NPI: 1407857865
Provider Name (Legal Business Name): MARK E OHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3460 SOUTH ST
MORRISVILLE NY
13408-9671
US

IV. Provider business mailing address

PO BOX 317
HAMILTON NY
13346-0317
US

V. Phone/Fax

Practice location:
  • Phone: 315-684-3117
  • Fax: 315-684-9848
Mailing address:
  • Phone: 315-824-6652
  • Fax: 315-824-6544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number193837
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: