Provider Demographics
NPI:1952365942
Name:ZWIESLER, MARY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:L
Last Name:ZWIESLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4700 SMITH RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2787
Mailing Address - Country:US
Mailing Address - Phone:513-619-6819
Mailing Address - Fax:513-645-2393
Practice Address - Street 1:7211 N MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-2566
Practice Address - Country:US
Practice Address - Phone:937-274-2117
Practice Address - Fax:937-274-9809
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2009-12-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35056835Z207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2207427Medicaid
OH2207427Medicaid
P00058720Medicare PIN
OH0645743Medicare PIN