1306841598 NPI number — DR. MARILYN J AGEE MD

Table of content: DR. MARILYN J AGEE MD (NPI 1306841598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306841598 NPI number — DR. MARILYN J AGEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGEE
Provider First Name:
MARILYN
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306841598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/17/2006
NPI Reactivation Date:
04/04/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 JEFFERSON AVE
Provider Second Line Business Mailing Address:
5TH FLOOR
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43604-7101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4126 N HOLLAND SYLVANIA RD STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43623-3537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-517-7600
Provider Business Practice Location Address Fax Number:
419-517-7610
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  35059145A , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0842413 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00098404 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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