Provider Demographics
NPI:1558434332
Name:SHORT, MARION PRISCILLA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:PRISCILLA
Last Name:SHORT
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 1:1363 E 55TH PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1709
Mailing Address - Country:US
Mailing Address - Phone:773-752-9141
Mailing Address - Fax:773-752-9142
Practice Address - Street 1:5841 SOUTH MARYLAND AVENUE
Practice Address - Street 2:MC4066 UNIVERSITY OF CHICAGO
Practice Address - City:CHCAGO
Practice Address - State:IL
Practice Address - Zip Code:60637
Practice Address - Country:US
Practice Address - Phone:773-702-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology