Provider Demographics
NPI:1275790974
Name:CONNER, MARILYN L (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:L
Last Name:CONNER
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 1:825 W LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-2118
Mailing Address - Country:US
Mailing Address - Phone:937-383-3402
Mailing Address - Fax:937-383-0610
Practice Address - Street 1:825 W LOCUST ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-2118
Practice Address - Country:US
Practice Address - Phone:937-383-3402
Practice Address - Fax:937-383-0610
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program