Provider Demographics
NPI:1831172634
Name:MARX-ARMILE, THERESA L (MD)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:L
Last Name:MARX-ARMILE
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 1:6615 CLINGAN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-2196
Mailing Address - Country:US
Mailing Address - Phone:330-757-7888
Mailing Address - Fax:330-757-4912
Practice Address - Street 1:6615 CLINGAN RD
Practice Address - Street 2:SUITE C
Practice Address - City:POLAND
Practice Address - State:OH
Practice Address - Zip Code:44514-2196
Practice Address - Country:US
Practice Address - Phone:330-757-7888
Practice Address - Fax:330-757-4912
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071012174400000X
PAMD421594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019696990001Medicaid
PA0019696990001Medicaid
PA073275RNOMedicare ID - Type Unspecified