Provider Demographics
NPI:1649375049
Name:MARR, EDGAR RAINER MARIA (MD)
Entity type:Individual
Prefix:
First Name:EDGAR
Middle Name:RAINER MARIA
Last Name:MARR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36465 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:
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35065001M207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0984592Medicaid
E 19059Medicare UPIN
0767254Medicare PIN
MA0767254Medicare PIN