Provider Demographics
NPI:1629230990
Name:FORD, MARLENE RAE (MT, ASCP)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:RAE
Last Name:FORD
Suffix:
Gender:F
Credentials:MT, ASCP
Other - Prefix:MS
Other - First Name:MARLENE
Other - Middle Name:RAE
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT, ASCP
Mailing Address - Street 1:4898 BACKUS RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-9751
Mailing Address - Country:US
Mailing Address - Phone:304-255-4926
Mailing Address - Fax:
Practice Address - Street 1:4898 BACKUS RD
Practice Address - Street 2:
Practice Address - City:MEADOW BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25976-9751
Practice Address - Country:US
Practice Address - Phone:304-255-4926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1601246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist