Provider Demographics
NPI:1790159333
Name:MARKWELL, HEATHER MARLENE (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARLENE
Last Name:MARKWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:MARLENE
Other - Last Name:HUGHES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3170 KETTERING BLVD BLDG B3
Mailing Address - Street 2:
Mailing Address - City:MORAINE
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1924
Mailing Address - Country:US
Mailing Address - Phone:937-991-3191
Mailing Address - Fax:937-223-9811
Practice Address - Street 1:7450 S MASON MONTGOMERY RD UNIT 200
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-8080
Practice Address - Country:US
Practice Address - Phone:513-204-5785
Practice Address - Fax:513-229-0228
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-19
Last Update Date:2018-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.13132497207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine