Healthcare Provider Details

I. General information

NPI: 1831137546
Provider Name (Legal Business Name): MARK F ZUSPAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6495 E BROAD ST STE J
COLUMBUS OH
43213
US

IV. Provider business mailing address

1195 WYANDOTTE RD
COLUMBUS OH
43212-3246
US

V. Phone/Fax

Practice location:
  • Phone: 614-863-3811
  • Fax: 614-863-8845
Mailing address:
  • Phone: 614-488-3026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35051920
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: