Provider Demographics
NPI:1891199311
Name:KOENIG, MARIE M (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:M
Last Name:KOENIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NA
Other - Middle Name:
Other - Last Name:NA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-S
Mailing Address - Street 1:800E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1015
Mailing Address - Country:US
Mailing Address - Phone:614-252-8300
Mailing Address - Fax:614-252-6637
Practice Address - Street 1:800 E BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1015
Practice Address - Country:US
Practice Address - Phone:614-252-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH004108363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant