Healthcare Provider Details

I. General information

NPI: 1699718916
Provider Name (Legal Business Name): MARION C DEMERS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 E WHITNEY AVE SUITE 1
SHELBY OH
44875-1246
US

IV. Provider business mailing address

24 E WHITNEY AVE SUITE 1
SHELBY OH
44875-1246
US

V. Phone/Fax

Practice location:
  • Phone: 419-347-2828
  • Fax: 419-347-2246
Mailing address:
  • Phone: 419-347-2828
  • Fax: 419-347-2246

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35073317D
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: