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NPI Code Detail

MEDICARE: MARIE KOENIG SIDDLE PA-C

MEDICARE: MARIE KOENIG SIDDLE PA-C
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
1363A00000XPhysician Assistant004108OH

General Provider Information

NPI Number : 1891199311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIE KOENIG SIDDLE PA-C
Provider Business Mailing Address
First Line : PO BOX 7527
Second Line :
City : DUBLIN
State : OH
Zip : 43017-0727
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1030 REFUGEE RD STE 280
Second Line :
City : PICKERINGTON
State : OH
Zip : 43147-0019
Country : US
Telephone Number : 614-788-4390
Fax Number : 614-788-4399
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2014
Last Update Date : 08/04/2024

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Directions to “ MARIE KOENIG SIDDLE PA-C” Practice Location

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