Healthcare Provider Details

I. General information

NPI: 1003011834
Provider Name (Legal Business Name): MARK SNIADANKO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE
OREGON OH
43616-3207
US

IV. Provider business mailing address

4750 HEMPSTEAD STATION DR
KETTERING OH
45429-5164
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7500
  • Fax:
Mailing address:
  • Phone: 800-875-0136
  • Fax: 937-619-3014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number34-008693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: