Provider Demographics
NPI:1679512164
Name:JONES, MARILYN (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:JONES
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 1:1 E NATIONAL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-2100
Mailing Address - Country:US
Mailing Address - Phone:937-531-0113
Mailing Address - Fax:937-531-0123
Practice Address - Street 1:1 E NATIONAL RD STE 100
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2100
Practice Address - Country:US
Practice Address - Phone:937-531-0113
Practice Address - Fax:937-531-0123
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.073326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084837Medicaid
G73072Medicare UPIN
OH2084837Medicaid
OH4070073Medicare PIN