| Marie C Walters, MD | |
| 
					601 State Route 664 N, Logan, OH 43138-8541  | |
| (740) 380-8000 | |
| (614) 293-2809 | 
| Full Name | Marie C Walters | 
|---|---|
| Gender | Female | 
| Speciality | Emergency Medicine | 
| Location | 601 State Route 664 N, Logan, Ohio | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1043891120 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 207P00000X | Emergency Medicine | 390200000X (Indiana) | Secondary | 
| 207P00000X | Emergency Medicine | 35.151662 (Ohio) | Primary | 
| Entity Name | Osup Community Outreach Llc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1699179929 PECOS PAC ID: 5799008082 Enrollment ID: O20141217001070  | 
| Mailing Address | Practice Location Address | 
|---|---|
| Marie C Walters, MD 700 Ackerman Rd Ste 2120, Columbus, OH 43202-1559 Ph: (740) 380-8000  | Marie C Walters, MD 601 State Route 664 N, Logan, OH 43138-8541 Ph: (740) 380-8000  | 
George T Ralph, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 601 St Rt 664 Box 966, Logan, OH 43138 Phone: 740-380-8000 Fax: 740-380-2932  | |
Lindsay L. Boik-price, DO Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 601 State Route 664 N, Logan, OH 43138 Phone: 740-380-8000  | |
Michael S. Abrahams, M.D. Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 601 State Route 664 N, Logan, OH 43138 Phone: 740-380-8000  | |
Mario C Villegas, MD Emergency Medicine Medicare: Not Enrolled in Medicare Practice Location: 601 State Route 664 N, Logan, OH 43138 Phone: 710-380-8000  | |
Neal E Bucher, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 601 State Route 664 N, Logan, OH 43138 Phone: 740-380-8000  | |
Martin Phillip Kasofsky, MD Emergency Medicine Medicare: Accepting Medicare Assignments Practice Location: 601 State Route 664 N, Logan, OH 43138 Phone: 740-380-8000  |