Provider Demographics
NPI:1760762520
Name:MAROHL, ALLIE M (CNM)
Entity Type:Individual
Prefix:
First Name:ALLIE
Middle Name:M
Last Name:MAROHL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 E 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-1002
Mailing Address - Country:US
Mailing Address - Phone:614-645-2700
Mailing Address - Fax:614-645-2727
Practice Address - Street 1:1500 E 17TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219
Practice Address - Country:US
Practice Address - Phone:614-645-2700
Practice Address - Fax:614-645-2727
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12567NM367A00000X
OHCOA.12567-NM367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0056976Medicaid
OHH033693Medicare PIN
OHH033692Medicare PIN
OHH033694Medicare PIN
OHH033690Medicare PIN
OHH033691Medicare PIN