1750467668 NPI number — DR. MARILYNN JOANNE PETERS M.D.

Table of content: DR. MARILYNN JOANNE PETERS M.D. (NPI 1750467668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750467668 NPI number — DR. MARILYNN JOANNE PETERS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PETERS
Provider First Name:
MARILYNN
Provider Middle Name:
JOANNE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSTON
Provider Other First Name:
MARILYNN
Provider Other Middle Name:
PETERS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750467668
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
871 MOSAIC CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAHANNA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43230-3835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-939-9051
Provider Business Mailing Address Fax Number:
614-939-9051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 BROOKSEDGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESTERVILLE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43081-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-882-9338
Provider Business Practice Location Address Fax Number:
614-882-3401
Provider Enumeration Date:
10/31/2006

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: 2084P0800X , with the licence number:  35-065586 , 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)





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