Healthcare Provider Details

I. General information

NPI: 1902929136
Provider Name (Legal Business Name): MARSHALL GORDON VARY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 OLENTANGY RIVER RD SUITE #412
COLUMBUS OH
43214-3907
US

IV. Provider business mailing address

6838 OAKFAIR AVE
COLUMBUS OH
43235-2735
US

V. Phone/Fax

Practice location:
  • Phone: 614-566-4925
  • Fax:
Mailing address:
  • Phone: 614-566-4925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35039617
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number35039617
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: