Provider Demographics
NPI:1790724250
Name:PRINCE, MARION R (DO)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:R
Last Name:PRINCE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5187 MAYFIELD RD STE 102
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:OH
Mailing Address - Zip Code:44124-2467
Mailing Address - Country:US
Mailing Address - Phone:440-449-2809
Mailing Address - Fax:440-442-3476
Practice Address - Street 1:5195 MAYFIELD RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LYNDHURST
Practice Address - State:OH
Practice Address - Zip Code:44124-2464
Practice Address - Country:US
Practice Address - Phone:440-442-0400
Practice Address - Fax:440-461-6005
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH34004052207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1790724250OtherNPI
OH0572072Medicaid
OHE96167Medicare UPIN
OHPR0768554Medicare ID - Type Unspecified