Basic Information
| Provider Information | |||||||||
| NPI: | 1477626034 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHARD B. MARKWOOD, DO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1103 VILLAGE SQUARE DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435511783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198723201 | ||||||||
| FaxNumber: | 4198723208 | ||||||||
| Practice Location | |||||||||
| Address1: | 1103 VILLAGE SQUARE DR | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | PERRYSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 435511783 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4198723201 | ||||||||
| FaxNumber: | 4198723208 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2006 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | MARKWOOD | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4198723201 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 34005681M | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2344270 | 05 | OH | MEDICAID |