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NPI Code Detail

MEDICARE: LAQUISHA S MARK MD

MEDICARE: LAQUISHA S MARK 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
1390200000XStudent in an Organized Health Care Education/Training Program57-014699OH

General Provider Information

NPI Number : 1679739163
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAQUISHA S MARK MD
Provider Business Mailing Address
First Line : 529 CRAWLEY RUN
Second Line : APT. #208
City : CENTERVILLE
State : OH
Zip : 45458-6396
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2345 PHILADELPHIA DR
Second Line :
City : DAYTON
State : OH
Zip : 45406-1816
Country : US
Telephone Number : 937-276-4141
Fax Number : 937-277-7249
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2008
Last Update Date : 12/02/2021

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