Provider Demographics
NPI:1619153103
Name:MAFFETT, MARISA DREISBACH (MD)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:DREISBACH
Last Name:MAFFETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARISA
Other - Middle Name:ALLISON
Other - Last Name:DREISBACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7450 HOSPITAL DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-9642
Mailing Address - Country:US
Mailing Address - Phone:614-659-9519
Mailing Address - Fax:614-659-0580
Practice Address - Street 1:7450 HOSPITAL DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43016-9642
Practice Address - Country:US
Practice Address - Phone:614-659-9519
Practice Address - Fax:614-885-7146
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.089111207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2871263Medicaid