Basic Information
| Provider Information | |||||||||
| NPI: | 1952365942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZWIESLER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 SMITH RD | ||||||||
| Address2: | SUITE A | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136196819 | ||||||||
| FaxNumber: | 5136452393 | ||||||||
| Practice Location | |||||||||
| Address1: | 7211 N MAIN ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454152566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372742117 | ||||||||
| FaxNumber: | 9372749809 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 12/30/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35056835Z | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2207427 | 05 | OH | MEDICAID |