Healthcare Provider Details

I. General information

NPI: 1831176155
Provider Name (Legal Business Name): MARK E GEBHART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3535 SOUTHERN BLVD
KETTERING OH
45429-1221
US

IV. Provider business mailing address

20 PRESTIGE PLZ SUITE 100
MIAMISBURG OH
45342-5354
US

V. Phone/Fax

Practice location:
  • Phone: 937-436-4658
  • Fax:
Mailing address:
  • Phone: 937-436-4658
  • Fax: 937-436-4984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number35075471
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35075471
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: