Healthcare Provider Details

I. General information

NPI: 1104010982
Provider Name (Legal Business Name): MARI MORI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2007
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

IV. Provider business mailing address

700 CHILDRENS DR
COLUMBUS OH
43205-2664
US

V. Phone/Fax

Practice location:
  • Phone: 614-722-6200
  • Fax: 614-722-4565
Mailing address:
  • Phone: 614-722-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0202X
TaxonomyClinical Biochemical Genetics Physician
License Number35-122728
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207SG0207X
TaxonomyMedical Biochemical Genetics
License Number35-122728
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number35-122728
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: