Provider Demographics
NPI:1699743708
Name:PAULOS, MARK R (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:PAULOS
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 1:1000 AUBURN DR STE 110
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4317
Mailing Address - Country:US
Mailing Address - Phone:216-285-5050
Mailing Address - Fax:216-285-4044
Practice Address - Street 1:1000 AUBURN DR STE 110
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4317
Practice Address - Country:US
Practice Address - Phone:216-285-5050
Practice Address - Fax:216-285-4044
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD14190207R00000X
OH35.149159207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA011867750Medicaid
PA052858PD9Medicare ID - Type Unspecified
PA011867750Medicaid