Provider Demographics
NPI:1053816637
Name:AZAR, MARLENE AZIZA (MD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:AZIZA
Last Name:AZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 MONTGOMERY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4460
Mailing Address - Country:US
Mailing Address - Phone:513-561-5655
Mailing Address - Fax:
Practice Address - Street 1:10615 MONTGOMERY RD STE 202
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-4460
Practice Address - Country:US
Practice Address - Phone:513-561-5655
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35.144852207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program