Basic Information
| Provider Information | |||||||||
| NPI: | 1265421531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHUDA | ||||||||
| FirstName: | MARIAN | ||||||||
| MiddleName: | KENNEDY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1299 OLENTANGY RIVER RD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432123135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145664278 | ||||||||
| FaxNumber: | 6145665424 | ||||||||
| Practice Location | |||||||||
| Address1: | 3724 A OLENTANGY RIVER RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145665858 | ||||||||
| FaxNumber: | 6145666807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0300X | 35044508 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine |
No ID Information.