Healthcare Provider Details

I. General information

NPI: 1760485064
Provider Name (Legal Business Name): GERALD WAYNE MARSA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2213 CHERRY ST
TOLEDO OH
43608-2603
US

IV. Provider business mailing address

4841 MONROE ST
TOLEDO OH
43623-4385
US

V. Phone/Fax

Practice location:
  • Phone: 419-251-4572
  • Fax: 419-251-3849
Mailing address:
  • Phone: 419-471-0490
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number35-036699M
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: