Healthcare Provider Details

I. General information

NPI: 1336144815
Provider Name (Legal Business Name): MARK W LAFFERTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2815 AARONWOOD AVE NE
MASSILLON OH
44646-2371
US

IV. Provider business mailing address

2815 AARONWOOD AVE NE
MASSILLON OH
44646-2371
US

V. Phone/Fax

Practice location:
  • Phone: 330-837-8300
  • Fax: 330-837-8111
Mailing address:
  • Phone: 330-837-8300
  • Fax: 330-837-8111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35-056424
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35-056424
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number35-056424
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: