Provider Demographics
NPI:1588870950
Name:BRAUNER, MARK EDWARD (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:BRAUNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2619 WELLESLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2957
Mailing Address - Country:US
Mailing Address - Phone:614-231-2619
Mailing Address - Fax:
Practice Address - Street 1:2619 WELLESLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43209-2957
Practice Address - Country:US
Practice Address - Phone:614-231-2619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008897207PH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PH0002XAllopathic & Osteopathic PhysiciansEmergency MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500602609Medicaid
ORR145768Medicare PIN