Provider Demographics
NPI:1487695615
Name:EINBECKER, MARK E (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:EINBECKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1780 NICHOLASVILLE RD
Mailing Address - Street 2:STE 501
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1400
Mailing Address - Country:US
Mailing Address - Phone:859-278-3481
Mailing Address - Fax:859-277-7365
Practice Address - Street 1:1780 NICHOLASVILLE RD
Practice Address - Street 2:STE 501
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1400
Practice Address - Country:US
Practice Address - Phone:859-278-3481
Practice Address - Fax:859-277-7365
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27473207X00000X, 207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64274731Medicaid
KY4577309OtherAETNA PROVIDER NUMBER
KY000000047278OtherBCBS NUMBER
KY4577309OtherAETNA PROVIDER NUMBER
KY1207904Medicare PIN