Provider Demographics
NPI:1700803699
Name:MARAZON, CHRISTOPHER TODD (DO)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:TODD
Last Name:MARAZON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5244
Mailing Address - Fax:740-446-6300
Practice Address - Street 1:1051 4TH AVE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1562
Practice Address - Country:US
Practice Address - Phone:740-446-5244
Practice Address - Fax:740-446-6300
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.008258207Q00000X, 208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020351Medicaid
OH000000492056OtherOH MEDICAID UNISON
OH310917085293OtherOH MEDICAID CARESOURCE
OH2932876Medicaid
OH310917085293OtherOH MEDICAID CARESOURCE