Healthcare Provider Details

I. General information

NPI: 1831172634
Provider Name (Legal Business Name): THERESA L MARX-ARMILE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2005
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 CLINGAN RD SUITE C
POLAND OH
44514-2196
US

IV. Provider business mailing address

6615 CLINGAN RD SUITE C
POLAND OH
44514-2196
US

V. Phone/Fax

Practice location:
  • Phone: 330-757-7888
  • Fax: 330-757-4912
Mailing address:
  • Phone: 330-757-7888
  • Fax: 330-757-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35071012
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: