MEDICARE: MACKENZIE BRYNNE MARLEY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	34.015894	OH

General Provider Information

NPI Number	:	1508362948
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACKENZIE BRYNNE MARLEY DO

Provider Business Mailing Address
First Line	:	605 N CLEVELAND MASSILLON RD STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2200
Country	:	US
Telephone Number	:	330-668-6545
Fax Number	:	330-668-2726

Provider Business Practice Location Address
First Line	:	605 N CLEVELAND MASSILLON RD STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44333-2200
Country	:	US
Telephone Number	:	330-668-6545
Fax Number	:	330-668-2726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	06/15/2022

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