Provider Demographics
NPI:1427339555
Name:LAMBERT, MARK HARRISON
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:HARRISON
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7520 TWP.RD 58
Mailing Address - Street 2:
Mailing Address - City:BLOOMVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44818
Mailing Address - Country:US
Mailing Address - Phone:419-983-5005
Mailing Address - Fax:
Practice Address - Street 1:7520 E TOWNSHIP ROAD 58
Practice Address - Street 2:
Practice Address - City:BLOOMVILLE
Practice Address - State:OH
Practice Address - Zip Code:44818-9448
Practice Address - Country:US
Practice Address - Phone:419-983-5005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2711533374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2711533Medicaid