Provider Demographics
NPI:1336537570
Name:EBENEZER, MARJORIE (MD MPH)
Entity Type:Individual
Prefix:DR
First Name:MARJORIE
Middle Name:
Last Name:EBENEZER
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1421 MORSE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-6423
Mailing Address - Country:US
Mailing Address - Phone:614-262-5094
Mailing Address - Fax:614-262-4255
Practice Address - Street 1:877 PELHAM CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-5577
Practice Address - Country:US
Practice Address - Phone:614-841-9086
Practice Address - Fax:614-841-9086
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-22
Last Update Date:2014-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.093334208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice