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NPI Code Detail

MEDICARE: MARK G DELWORTH JR. MD

MEDICARE:   MARK G DELWORTH JR. MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician35-06-8560OH

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3490003987OTHEROHRAILROAD MEDICARE

Other Identifiers

General Provider Information

NPI Number : 1275579856
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK G DELWORTH JR. MD
Provider Business Mailing Address
First Line : 2000 JOSEPH E SANKER BLVD
Second Line :
City : CINCINNATI
State : OH
Zip : 45212-1979
Country : US
Telephone Number : 513-841-7400
Fax Number : 513-841-7402
Provider Business Practice Location Address
First Line : 10220 ALLIANCE RD
Second Line :
City : BLUE ASH
State : OH
Zip : 45242-4710
Country : US
Telephone Number : 513-841-7800
Fax Number : 513-841-7801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/21/2006
Last Update Date : 12/02/2014

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