Healthcare Provider Details

I. General information

NPI: 1326400821
Provider Name (Legal Business Name): MARJA BROLINSON KING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJA GABRIELLE BROLINSON MD

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 EDWARDS RD STE 450
CINCINNATI OH
45209-1948
US

IV. Provider business mailing address

3805 EDWARDS RD STE 450
CINCINNATI OH
45209-1948
US

V. Phone/Fax

Practice location:
  • Phone: 513-509-6621
  • Fax: 513-924-5551
Mailing address:
  • Phone: 513-509-6621
  • Fax: 513-924-5551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number35.139121
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number35.139121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: