Healthcare Provider Details

I. General information

NPI: 1174064604
Provider Name (Legal Business Name): MARK ALBERT LORENZINI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 W BROAD ST
COLUMBUS OH
43228-1607
US

IV. Provider business mailing address

1812 HERITAGE POND DR APT 106
CHARLOTTE NC
28262-5548
US

V. Phone/Fax

Practice location:
  • Phone: 614-544-2780
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS20445
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: