Provider Demographics
NPI:1114045788
Name:SHOLITON, MARILYN C (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:C
Last Name:SHOLITON
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 1:3120 BURNET AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229
Mailing Address - Country:US
Mailing Address - Phone:513-221-2525
Mailing Address - Fax:513-221-4007
Practice Address - Street 1:3120 BURNET AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229
Practice Address - Country:US
Practice Address - Phone:513-221-2525
Practice Address - Fax:513-221-4007
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350251982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A70681Medicare UPIN
OHSH0126124Medicare PIN