1316957517 NPI number — CHRIS MARQUART M.D.

Table of content: CHRIS MARQUART M.D. (NPI 1316957517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316957517 NPI number — CHRIS MARQUART M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARQUART
Provider First Name:
CHRIS
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1316957517
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
348 TOWNSEND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AKRON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44319-3562
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-354-7467
Provider Business Mailing Address Fax Number:
330-354-7467

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1450 FIRESTONE PKWY STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AKRON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44301-1655
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-724-3345
Provider Business Practice Location Address Fax Number:
330-724-5299
Provider Enumeration Date:
08/09/2006

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: 208D00000X , with the licence number:  35045020 , 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: 0437969 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".