Provider Demographics
NPI:1063464873
Name:DEMUND, MARJORIE ANN (MD)
Entity Type:Individual
Prefix:
First Name:MARJORIE
Middle Name:ANN
Last Name:DEMUND
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 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-226-5018
Mailing Address - Fax:419-998-4514
Practice Address - Street 1:1220 E ELM ST STE 101
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2803
Practice Address - Country:US
Practice Address - Phone:419-998-8245
Practice Address - Fax:419-998-8247
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38559207V00000X
SC39220207VX0000X
OH35.052164207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0879090Medicaid
OH4251661OtherMEDICARE ID
OHDE0706579OtherMEDICARE ID
SCSC93398566OtherMEDICARE NUMBER FOR SOUTH CAROLINA
OH0879090Medicaid
OHH346710Medicare PIN
OH0879090Medicaid