Provider Demographics
NPI:1023011947
Name:MARLOWE, CHARLES RUSSELL JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:RUSSELL
Last Name:MARLOWE
Suffix:JR
Gender:M
Credentials:DPM
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Mailing Address - Street 1:5757 MONCLOVA RD
Mailing Address - Street 2:STE 5
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1863
Mailing Address - Country:US
Mailing Address - Phone:419-893-5757
Mailing Address - Fax:419-893-5399
Practice Address - Street 1:1021 SANDUSKY ST STE A
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3120
Practice Address - Country:US
Practice Address - Phone:419-874-4494
Practice Address - Fax:419-874-7258
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-24
Last Update Date:2020-02-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH36001487213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT80341Medicare UPIN