Provider Demographics
NPI:1992128581
Name:SMITH, MARK HARRISON (MPA, CPM)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:HARRISON
Last Name:SMITH
Suffix:
Gender:M
Credentials:MPA, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 SYCAMORE RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-5605
Mailing Address - Country:US
Mailing Address - Phone:614-301-4902
Mailing Address - Fax:
Practice Address - Street 1:346 SYCAMORE RIDGE WAY
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-5605
Practice Address - Country:US
Practice Address - Phone:614-301-4902
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-03
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator