Healthcare Provider Details

I. General information

NPI: 1407040884
Provider Name (Legal Business Name): MARK E JOHNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2007
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 IVY GTWY STE 1100
CINCINNATI OH
45245-1995
US

IV. Provider business mailing address

5053 WOOSTER RD
CINCINNATI OH
45226-2326
US

V. Phone/Fax

Practice location:
  • Phone: 513-751-2273
  • Fax:
Mailing address:
  • Phone: 513-751-2145
  • Fax: 513-751-2138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number47008
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number35.125806
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: