Healthcare Provider Details

I. General information

NPI: 1164560249
Provider Name (Legal Business Name): MARK WESLEY VOGELGESANG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 DRESSLER RD NW SUITE 100
CANTON OH
44718-2784
US

IV. Provider business mailing address

104 EAST DRIVE
HARTVILLE OH
44632-8891
US

V. Phone/Fax

Practice location:
  • Phone: 330-479-3333
  • Fax: 330-479-3334
Mailing address:
  • Phone: 330-877-1228
  • Fax: 866-422-7933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number47614
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: