Active NPI
Mark D Fine, M.D.
- Internal Medicine Physician
- Sylvania, OH
National Provider Identifier
1295736924
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 35038934F
- Practice address
- 7640 Sylvania Ave
I
Sylvania, OH 43560-9729 - Phone
- (419) 517-4000
- Fax
- (419) 517-4001
- NPI assigned
- Aug 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 35038934F | OH | Primary |
Addresses
Primary practice location
7640 Sylvania Ave
I
Sylvania, OH 43560-9729
Mailing address
7640 Sylvania Ave
I
Sylvania, OH 43560-9729
Phone (419) 517-4000
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00011 | Other | OH | PARAMOUNT |
| 283760 | Other | OH | UNITED HEALTH CARE |
| 000000130369 | Other | OH | ANTHEM BCBS |
| 0353862 | Medicaid | OH | |
| 4002408 | Other | OH | AETNA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35038934F | OH | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1123027200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1192492800000",
"number": "1295736924",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7640 SYLVANIA AVE",
"address_2": "I",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435609729",
"telephone_number": "419-517-4000",
"fax_number": "419-517-4001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7640 SYLVANIA AVE",
"address_2": "I",
"city": "SYLVANIA",
"state": "OH",
"postal_code": "435609729",
"telephone_number": "419-517-4000",
"fax_number": "419-517-4001"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FINE",
"first_name": "MARK",
"middle_name": "D",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-03",
"last_updated": "2007-10-16",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "OH",
"license": "35038934F",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PARAMOUNT",
"identifier": "00011",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTH CARE",
"identifier": "283760",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000130369",
"state": "OH"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0353862",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4002408",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sylvania, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.