Provider Demographics
NPI:1851464002
Name:EDGAR R MARR MD INC
Entity Type:Organization
Organization Name:EDGAR R MARR MD INC
Other - Org Name:CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:R M
Authorized Official - Last Name:MARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-934-5236
Mailing Address - Street 1:36465 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1576
Mailing Address - Country:US
Mailing Address - Phone:440-934-5236
Mailing Address - Fax:
Practice Address - Street 1:36465 DETROIT RD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1576
Practice Address - Country:US
Practice Address - Phone:440-934-5236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0984592Medicaid
SP02201Medicare ID - Type Unspecified
E19059Medicare UPIN