Provider Demographics
NPI:1174569362
Name:PLISKIN, MARC J (DO)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:PLISKIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 JOSEPH E SANKER BLVD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-1979
Mailing Address - Country:US
Mailing Address - Phone:513-841-7400
Mailing Address - Fax:513-841-7402
Practice Address - Street 1:3301 MERCY HEALTH BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45211-1104
Practice Address - Country:US
Practice Address - Phone:513-841-7700
Practice Address - Fax:513-841-7701
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-5378208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0913999Medicaid
OH0276946Medicaid
OH340018919OtherRAILROAD MEDICARE
KY64031420Medicaid
OH0705707Medicare PIN
OHF08996Medicare UPIN
OH4051951Medicare PIN
OH0705709Medicare PIN
OH0913999Medicaid
KY64031420Medicaid