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General NPI Number Information
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NPI Number | 1215199401
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Entity Type | Individual
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Provider Name | MARISSA MAIA MERTZ M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 06/27/2008
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Provider Practice Location Address
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Address Line | 697 THOMAS LN
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City | COLUMBUS
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State | OH
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Zip | 43214-3931
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Country | US
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Telephone | 614-566-4398
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Fax | 614-566-6843
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Provider Business Mailing Address
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Address Line | 697 THOMAS LN
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City | COLUMBUS
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State | OH
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Zip | 43214-3931
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Country | US
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Telephone | 614-566-4398
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Fax | 614-566-6843
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35.091568
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License Number State | OH
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