Provider Demographics
NPI:1821109877
Name:MARSH, RAMONA C (MD)
Entity Type:Individual
Prefix:
First Name:RAMONA
Middle Name:C
Last Name:MARSH
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 1:885 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6141
Mailing Address - Country:US
Mailing Address - Phone:630-653-4240
Mailing Address - Fax:630-933-4581
Practice Address - Street 1:885 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6141
Practice Address - Country:US
Practice Address - Phone:630-653-4240
Practice Address - Fax:630-933-4581
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-076115207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL02223000OtherBLUE CROSS BLUE SHIELD
ILF400118979OtherMEDICARE (INDIVIDUAL) PTAN
IL036076115Medicaid
IL206147OtherMEDICARE (GROUP) PTAN
IL036076115OtherMEDICAID
IL206147OtherMEDICARE (GROUP) PTAN