Provider Demographics
NPI:1295812485
Name:PETERS, MARIANNE B (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANNE
Middle Name:B
Last Name:PETERS
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 1:1773 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1007
Mailing Address - Country:US
Mailing Address - Phone:513-557-3503
Mailing Address - Fax:
Practice Address - Street 1:463 OHIO PIKE
Practice Address - Street 2:SUITE 306
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45255-3721
Practice Address - Country:US
Practice Address - Phone:513-474-7778
Practice Address - Fax:512-474-2296
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071759207R00000X
IN01045888A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055538Medicaid
OHPE0818823Medicare PIN
P00072688Medicare PIN
G45051Medicare UPIN