Healthcare Provider Details

I. General information

NPI: 1396543609
Provider Name (Legal Business Name): MARIE CHRISTINE WITHROW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2025
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 WASHINGTON ST
CHAGRIN FALLS OH
44022-4403
US

IV. Provider business mailing address

551 WASHINGTON ST
CHAGRIN FALLS OH
44022-4403
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-9400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9119950
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010467RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: