Healthcare Provider Details

I. General information

NPI: 1801886130
Provider Name (Legal Business Name): MARK D FILDES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL SUITE 2750
YOUNGSTOWN OH
44512-7004
US

IV. Provider business mailing address

250 DEBARTOLO PL SUITE 2750
YOUNGSTOWN OH
44512-7004
US

V. Phone/Fax

Practice location:
  • Phone: 330-758-7703
  • Fax: 330-758-4930
Mailing address:
  • Phone: 330-758-7703
  • Fax: 330-758-4930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35043050
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35043050
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD061230L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: