Provider Demographics
NPI:1548358922
Name:NAUMAN, MARY LOUISE (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:NAUMAN
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 1:1231 LEICESTER PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-2181
Mailing Address - Country:US
Mailing Address - Phone:614-846-9926
Mailing Address - Fax:614-848-6736
Practice Address - Street 1:19900 STATE ROUTE 739
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9256
Practice Address - Country:US
Practice Address - Phone:937-642-0298
Practice Address - Fax:937-645-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH43568204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2717Medicare UPIN