| Mary Wonderly Md Llc | |
|
2575 Hayes Ave Ste 5 Fremont OH 43420-5201 | |
| (419) 332-3560 | |
| (419) 332-3565 |
| Full Name | Mary Wonderly Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2575 Hayes Ave Ste 5, Fremont, Ohio |
| Authorized Official Name and Position | Denise Kerlin (OFFICE MANAGER) |
| Authorized Official Contact | 4193323560 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Wonderly Md Llc 2575 Hayes Ave Ste 5 Fremont OH 43420-5201 Ph: (419) 332-3560 | Mary Wonderly Md Llc 2575 Hayes Ave Ste 5 Fremont OH 43420-5201 Ph: (419) 332-3560 |
| NPI Number | 1912167750 |
|---|---|
| Provider Enumeration Date | 06/16/2008 |
| Last Update Date | 11/26/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912167750 | NPI | - | NPPES |
| 2825045 | Medicaid | OH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 35-082561 (Ohio) | Primary |
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