Healthcare Provider Details

I. General information

NPI: 1568478626
Provider Name (Legal Business Name): MARK JOHN PIACENTINI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 E WATER ST
PROSPECT OH
43342
US

IV. Provider business mailing address

102 E WATER ST
PROSPECT OH
43342
US

V. Phone/Fax

Practice location:
  • Phone: 740-494-2624
  • Fax: 740-494-9013
Mailing address:
  • Phone: 740-494-2624
  • Fax: 740-494-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number35054820P
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35054820
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: