Provider Demographics
NPI:1447217864
Name:GREENBAUM, MARIE MORELLI (DO)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:MORELLI
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2702 NAVARRE AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3223
Mailing Address - Country:US
Mailing Address - Phone:419-691-8000
Mailing Address - Fax:419-693-0111
Practice Address - Street 1:2702 NAVARRE AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3223
Practice Address - Country:US
Practice Address - Phone:419-691-8000
Practice Address - Fax:419-693-0111
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007737G207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2290864Medicaid
OHG70765Medicare UPIN
OHGR4065761Medicare ID - Type Unspecified