MARK DAVID IMWALLE MD NPI 1740284538

NPI Information

NPI: 1740284538
Provider Name: MARK DAVID IMWALLE, MD
Classification: Radiology - 2085R0202X
Entity Type: Individual

Specialization: Diagnostic Radiology

PECOS Registration: Yes

Address:
3000 MACK RD
FAIRFIELD, OH
ZIP 45014
Phone: (513) 870-7024
Get Directions

Mark David Imwalle, MD is a diagnostic radiology radiology in Fairfield, OH. The provider is a radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease. Mark David Imwalle, MD NPI is 1740284538. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

3000 MACK RD
FAIRFIELD, OH
ZIP 45014-335
Phone: (513) 870-7024
Fax: (513) 965-8091

The NPI 1740284538 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/9/2005 and was last updated on 2/25/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	2085R0202X	Radiology	Diagnostic Radiology	35031812I	OHIO	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State
1	E59714	MEDICARE UPIN	OHIO
2	64781099	MEDICAID	KENTUCKY
3	0349644	MEDICAID	OHIO
4	0151181	MEDICARE PIN	OHIO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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