Provider Demographics
NPI:1184814790
Name:WEBER, MARREN J (DO)
Entity Type:Individual
Prefix:
First Name:MARREN
Middle Name:J
Last Name:WEBER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9500 MENTOR AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060
Mailing Address - Country:US
Mailing Address - Phone:440-352-4880
Mailing Address - Fax:440-352-3629
Practice Address - Street 1:9500 MENTOR AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060
Practice Address - Country:US
Practice Address - Phone:440-352-4880
Practice Address - Fax:440-352-3629
Is Sole Proprietor?:No
Enumeration Date:2007-07-30
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036120087207Q00000X
OH34-009759207Q00000X
OH34.009759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine