Organization
MARY WONDERLY MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DENISE KERLIN (OFFICE MANAGER)
(419) 332-3560
Entity
Organization
Contact information
Practice address
2575 HAYES AVE STE 5, FREMONT, OH 43420-5201
(419) 332-3560
(419) 332-3565
Mailing address
2575 HAYES AVE STE 5, FREMONT, OH 43420-5201
(419) 332-3560
(419) 332-3565
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35-082561
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2825045
—
OH
Enumeration date
06/16/2008
Last updated
11/26/2008
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