Healthcare Provider Details

I. General information

NPI: 1629380878
Provider Name (Legal Business Name): MARK FRANCIS SHOREMAN I MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2010
Last Update Date: 03/06/2024
Certification Date: 03/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 MIAMISBURG CENTERVILLE RD
MIAMISBURG OH
45342-7615
US

IV. Provider business mailing address

PO BOX 645525
CINCINNATI OH
45264-3359
US

V. Phone/Fax

Practice location:
  • Phone: 937-384-8797
  • Fax: 937-384-8786
Mailing address:
  • Phone: 937-298-5536
  • Fax: 937-298-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAR 2812750 RS54
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number35.121300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: