Healthcare Provider Details

I. General information

NPI: 1992760474
Provider Name (Legal Business Name): MARK KISSINGER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/06/2020
Certification Date: 05/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MAIN ST
WINTERSVILLE OH
43953-3733
US

IV. Provider business mailing address

380 SUMMIT AVE MSO PHYSICIAN BILLING
STEUBENVILLE OH
43952-2667
US

V. Phone/Fax

Practice location:
  • Phone: 740-264-1656
  • Fax: 740-266-2936
Mailing address:
  • Phone: 740-283-7597
  • Fax: 740-283-7190

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34007545
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: