Healthcare Provider Details

I. General information

NPI: 1871290270
Provider Name (Legal Business Name): MARIE COBB PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7707 PARAGON RD
CENTERVILLE OH
45459-4041
US

IV. Provider business mailing address

243 SANDERSON DR
DAYTON OH
45459-1908
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-6920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number50-008015
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.008015
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: