| Doctor Name: | MARK EDWARD WAIDE |
| NPI Number: | 1548244353 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | 1032163 |
| Business Practice Address: | 9150 Market Square Dr Suite 202 Streetsboro, OH - 442414571 |
| Business Phone Number: | 3306262211 |
| Business Fax Number: | 3306262294 |
| Mailing Address: | 9150 Market Square Dr, Suite 202 STREETSBORO |
| State: | OH |
| Postal Code: | 442414571 |
| Phone Number: | 3306262211 |
| Fax Number: | 3306262294 |
| NPI Enumeration Date: | 12/05/2005 |
| NPI Last Update Date: | 08/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 1032163 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |