Provider Demographics
NPI:1285620179
Name:TAWIL, MARK T (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:T
Last Name:TAWIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5231 FOXCHASE AVE NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-1588
Mailing Address - Country:US
Mailing Address - Phone:234-207-6867
Mailing Address - Fax:
Practice Address - Street 1:6659 FRANK AVE. NW
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720
Practice Address - Country:US
Practice Address - Phone:330-966-3772
Practice Address - Fax:330-966-3799
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY53126208G00000X
OH35060120208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0845750Medicaid
OH678755OtherANTHEM BCBS
OH0790083Medicare ID - Type Unspecified
OH678755OtherANTHEM BCBS
OH0845750Medicaid