Mark Edward Waide, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

2570 Issued in OH

Practice address

9150 Market Square Dr
Suite 202
Streetsboro, OH 44241-4571

Phone

(330) 626-2211

Fax

(330) 626-2294

NPI assigned

Dec 5, 2005

Last updated

Aug 30, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• A Northcoast Ear, Nose and Throat, Inc

  • Plastic Surgery within the Head & Neck (Otolaryngology) Physician
  • Mayfield Heights, OH
  • NPI 1629266747
  NPD (past)
• Primary Care Assoc of N

  • Internal Medicine Physician
  • Kent, OH
  • NPI 1336195932
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1346284800000",
    "number": "1548244353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9150 MARKET SQUARE DR",
            "address_2": "SUITE 202",
            "city": "STREETSBORO",
            "state": "OH",
            "postal_code": "442414571",
            "telephone_number": "330-626-2211",
            "fax_number": "330-626-2294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9150 MARKET SQUARE DR",
            "address_2": "SUITE 202",
            "city": "STREETSBORO",
            "state": "OH",
            "postal_code": "442414571",
            "telephone_number": "330-626-2211",
            "fax_number": "330-626-2294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAIDE",
        "first_name": "MARK",
        "middle_name": "EDWARD",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2012-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CT",
            "license": "1032163",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "OH",
            "license": "2570",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0067558",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Utc Trans LLC
• Amar Pankaj Vagadia, D.M.D
• Kallie Daniele Van Coppenolle
• Luong Van Vo, M.D.
• Morgan Voytek, LPC
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2313)
• Wal-Mart Stores East, LP (Vision Center 2313)
• Walgreen Co. (Walgreens #09346)
• Jesseca Marie Wallace
• Kuei-Mei Wang, NP

• Medical Physician Assistant in Streetsboro, OH
• Providers in Streetsboro, OH by specialty
• Medical Physician Assistant in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.