Healthcare Provider Details

I. General information

NPI: 1427339555
Provider Name (Legal Business Name): MR. MARK HARRISON LAMBERT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 E TOWNSHIP ROAD 58
BLOOMVILLE OH
44818-9448
US

IV. Provider business mailing address

7520 TWP.RD 58
BLOOMVILLE OH
44818
US

V. Phone/Fax

Practice location:
  • Phone: 419-983-5005
  • Fax:
Mailing address:
  • Phone: 419-983-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2711533
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: