Provider Demographics
NPI:1598733347
Name:TIU, MARILYN C (MD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:C
Last Name:TIU
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 1:15549 STATE ROUTE 170
Mailing Address - Street 2:UNIT #5
Mailing Address - City:EAST LIVERPOOL
Mailing Address - State:OH
Mailing Address - Zip Code:43920-9216
Mailing Address - Country:US
Mailing Address - Phone:330-385-1477
Mailing Address - Fax:330-385-1485
Practice Address - Street 1:15549 STATE ROUTE 170
Practice Address - Street 2:UNIT #5
Practice Address - City:EAST LIVERPOOL
Practice Address - State:OH
Practice Address - Zip Code:43920-9216
Practice Address - Country:US
Practice Address - Phone:330-385-1477
Practice Address - Fax:330-385-1485
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.071087208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0231841Medicaid
OH000000554885OtherANTHEM BLUE SHIELD
WV1806610000OtherWEST VIRGINIA MEDICAID