Provider Demographics
NPI:1336104009
Name:TWYMAN, MARLON DE MARCIE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLON
Middle Name:DE MARCIE
Last Name:TWYMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 MERCHANT STREET
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3740
Mailing Address - Country:US
Mailing Address - Phone:513-533-1199
Mailing Address - Fax:513-645-9827
Practice Address - Street 1:1152 W THIRD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45402-6812
Practice Address - Country:US
Practice Address - Phone:937-268-3483
Practice Address - Fax:937-268-1884
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056382T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0705544Medicaid
OH0705544Medicaid
P00070561Medicare PIN
OHA17562Medicare UPIN